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1) What information 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). These can all be accessed via http://www.sor.org/practice/ultrasound/health-safety-sonographers

As far as a strictly legal requirement to breaks under the Working Time Regulations are concerned the following website gives information http://www.hse.gov.uk/contact/faqs/workingtime.htm

Mini-breaks are important with regards to good scanning practice and are also discussed in the above SCoR documents. 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 CPD activities although this 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 saving. 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 DQASS, student mentoring and protocol updating to attend to that can all form part of a working day and are 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.

There is an excellent ‘on-line’ resource that has been produced to support the 18w to 20w 6d fetal anomaly screening scan. There is further advice here as to room design (with a ‘virtual’ ideal room) and how to reduce the incidence of WRMSD. The information is well presented and there are links to other relevant documents and websites, including    the SCoR.

Go to ‘What’s in the hexagons’, section 2.5. Note; website ceased operation; 2015-07-20.

Section 1.7 on Page 14 of the United Kingdom Association of Sonographers ‘Guidelines for Professional Working Standards’ has information relating to ergonomic practice. (UKAS merged with the College of Radiographers in January 2009). They are available at http://www.sor.org/learning/document-library/guidelines-professional-wor...

The Fetal Anomaly screening Programme has commissioned the 'Kinghorn' project led by Tom Brown to investigate this area and come up with possible solutions.

Tom Brown is one of the three original UK ultrasound pioneers (Donald, McVicar and Brown) and is an engineer by profession.

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... 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. http://www.sor.org/practice/ultrasound/health-safety-sonographers

Exercises for sonographers can be found in the SCoR document ‘Prevention of Work-related Musculoskeletal Disorders in Sonography’ and also via on-line searches.

Courses on the use of the Alexander Technique for sonographers have proved popular.

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.

FASP provide guidance (Standards 6.3, 6.4) with respect to repeat examinations on those women attending for the 18w – 20w 6d screening scan and where the image quality is compromised by e.g. an increased BMI. This document is available from http://fetalanomaly.screening.nhs.uk/standardsandpolicies

Trusts and Health Boards should have back care and ergonomics advisors who are able to give advice and undertake risk assessments. SoR Health and Safety Representatives can also undertake risk assessments.

The FASP ‘Manual for Sonographers’ that supports first trimester screening includes information on recommended room lighting levels. Available from http://fetalanomaly.screening.nhs.uk/sssresources

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