ENS Event | |
|---|---|
05:00 Dec 15, 2021 | |
| Title | Medical Event Due to Incorrect Treatment Area |
| Event Description | The following was received from the Florida Bureau of Radiation Control (the Bureau) via email:
On Friday, December 31, 2021, the Bureau was contacted by [the Radiation Safety Officer] to report a medical event at Horizon Medical Services that occurred on December 15, 2021. The medical event was the [high dose rate therapy] treatment of the incorrect hand using iridium-192 to a single dose fraction of 250 cGy [(250 rem)] to a depth of 3mm below the skin surface. The licensee's report to the Bureau stated, "Remedial action included an immediate in-service discussion of this event with the entire clinical staff to verify the correct anatomical treatment site regarding all patient prescriptions. The patient has been informed of this medical event. Florida Incident No.: FL 21-152 A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient. |
| Where | |
|---|---|
| Horizon Medical Services Tamarac, Florida (NRC Region 1) | |
| License number: | RAML 4 |
| Organization: | Florida Bureau Of Radiation Control |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+488.78 h20.366 days <br />2.909 weeks <br />0.67 months <br />) | |
| Opened: | Jason Nicholson 13:47 Jan 4, 2022 |
| NRC Officer: | Ossy Font |
| Last Updated: | Jan 4, 2022 |
| 55687 - NRC Website | |
Horizon Medical Services with Agreement State | |
WEEKMONTHYEARENS 556872021-12-15T05:00:00015 December 2021 05:00:00
[Table view]Agreement State Medical Event Due to Incorrect Treatment Area 2021-12-15T05:00:00 | |