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1) What information and general advice is available on WRMSD?

A sonographer should aim for what might be called ‘sensible scanning' practices. If a sonographer feels that conditions are likely to induce or exacerbate WRMSD, whether it be due to the workload, inadequate equipment, reporting facilities, high patient BMI, or other reasons then it is their professional duty to inform their manager, preferably in writing, at an early stage.
 
The SCoR has published several documents that give advice on work related musculo-skeletal disorders and how their incidence can be reduced. These can all be accessed via: https://www.sor.org/practice/ultrasound/health-safety-sonographers 
 
In 2012 the Health and Safety Executive published a report on WRMSD problems in ultrasound which is advised reading: http://www.hse.gov.uk/healthservices/management-of-musculoskeletal-disor...
 
As far as a strictly legal requirement to work-breaks under the Working Time Regulations are concerned, the following website gives information: http://www.hse.gov.uk/contact/faqs/workingtime.htm
 
Mini and micro-breaks are important with regards to good scanning practice and are also discussed in the above SCoR documents. These can be as simple as taking the transducer off the patient and resting the arm while taking measurements.
 
Breaks in scanning can be for a variety of work-related reasons as well as scheduled rest breaks such as for lunch. Time should be allowed for Continuing Professional Development (CPD) activities although allowing time for CPD is unfortunately not mandatory for most sonographers.  
 
Trusts and Health Boards do have mandatory requirements for training, some of which are on-line and can be completed over several days e.g. infection control, risk management, health and safety, basic life support. These will all need time to complete and may help break up what, in some departments, can be an extended day. There is also audit, multi-disciplinary team meetings, reporting discrepancy meetings, Fetal Anomaly Screening Programme (FASP) quality procedures including the Down’s Syndrome Screening Quality Assurance Support Service (DQASS), student mentoring and protocol updating to attend to that can all form part of a working day and can be considered as breaks from physical scanning. 
 
If at all possible, scanning lists should have a variety of case types rather than a long sequence of the same types of examination to vary muscle movements.  
 
Two documents relating to ultrasound service delivery are of relevance: 
RCR/SCoR (2014) ‘Standards for the Provision of an Ultrasound Service’ 
 
SCoR/BMUS (2015) ‘Guidelines for Professional Ultrasound Practice https://www.sor.org/sites/default/files/document-versions/ultrasound_gui...
Section 1.9.  Note: SCoR or BMUS log-in required.
 
The Visual Display Unit (VDU) regulations apply and sonographers and managers should be aware of these. Employers should provide free eyesight tests or allow re-imbursement of the cost of the test. https://www.sor.org/learning/document-library/vdu-regulations-hs-display...
(Please see also section 4 below)
 
There are 'body mapping' tools available from the SCoR website. These can help with recording where individual sonographers experience pain or discomfort. https://www.sor.org/learning/document-library?sort_by=field_date_publish...
 
Exercises for sonographers can be found in the 2007 SCoR document ‘Prevention of Work Related Musculoskeletal Disorders in Sonography’ via https://www.sor.org/practice/ultrasound/health-safety-sonographers and also via on-line searches. Stretching and warm-up exercises prior to a scanning session have been found to be effective by many sonographers.  
 
Courses on the use of the Alexander Technique for sonographers have proved popular to improve awareness of posture and movement. 
 
Try scanning in different positions (e.g. standing or sitting) and find what is most comfortable for you. Be ‘body aware’. 
 
From a prevention of WRMSD perspective ultrasound examinations on wards should be limited to those cases where the examination is clinically important and the patient cannot be brought safely to the department. This guidance can be relaxed if there are proper facilities for scanning on wards, the equipment is suitable and the proposed scanning activity has been risk-assessed. 
              
Trusts and Health Boards should have back care and ergonomics advisors available who are able to give advice and undertake risk assessments. SCoR Health and Safety Representatives can also undertake risk assessments.  
 
Independent providers and those working in the community should ensure that the published good practice principles associated with room layout and design, environment, sonographer chairs and examination couches are also applied.  Equipment selected should be suitable for the task required.  
 
The temperature of the ultrasound room should be able to be set as required by the sonographer for a more comfortable working environment. Ultrasound rooms tend to be overheated and air conditioning can be very welcome although a room that is too cold can also exacerbate muscular injury and can, in addition, be a problem from the point of view of patient care.  Having effective control of room temperature will, in turn, lead to a more productive and less stressful working environment. Equipment must be stored and used following the manufacturer’s published advice with respect to room temperature. 
 
Room lighting should be subdued but not to the point that movement becomes hazardous. 
 
Slave monitors are recommended by FASP for the two obstetric screening scans under their remit. 
 
Ensure that the patient is as close as possible to the edge of the couch thereby minimising the load on the scanning arm through unnecessary leaning and arm abduction. Note that the arm operating the machine controls should also not be extended for long periods as this can exacerbate problems. 
When using a computer for reporting during a scan, try to avoid holding the probe on the patient while entering data with the other hand.
 
The use of the couch Trendelenburg (head down) function if available can help improve visualisation of the fetus when it is positioned low in the maternal pelvis.
 
A relaxed abdomen is easier to scan than a tense one.  Careful explanation and the use of patient relaxation techniques can help to reduce the overall time of the examination. 
 

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