NHS Fife Policy for Requesting Radiological Investigations by Non-Medical Healthcare Professionals

NHS Fife Policy for Requesting Radiological Investigations by Non-Medical Healthcare Professionals

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 1 of 18 Appendix 2 Requesting Radiological Investigations by Non-Medical Healthcare Professionals Clinical area specific non-medical referrer standard operating procedures 1. A&E and Minor injuries Emergency Nurse Practitioner 2. Rheumatology Specialist Nurse 3. Specialist Physiotherapist 4. Hospital at Night Advanced Nurse Practitioner 5.

Health Protection Nurse (TB) 6. Paediatric Nurse Practitioner 7. Specialist Podiatrist 8. General Practice Nurse Practitioner 9. Bone Densitometry Referrer 10.Neonatal Nurse Practitioner 11.Radiographer 12.Acute Medical Nurse Practitioner 13.Orthopaedic Paediatric Specialist Physiotherapist 14.Cardiology Nurse Practitioner 15.Upper Gastro Intestinal Nurse Specialist

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 2 of 18 1 PROCEDURE FOR A&E AND MINOR INJURIES EMERGENCY NURSE PRACTITIONER (ENP) REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of A&E or minor injury patients, there will, under certain circumstances, be a role for agreed nurse practitioners making requests for radiological examinations. This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved ENP’s. An up to date list of referring ENP’s with specimen signatures should be held by the radiology department or requests will be refused. 2. Requests will be limited to: Fingers, Thumb, Hand, Wrist, Scaphoid, Elbow, Shoulder, Toe, Foot, Ankle, and Knee x- ray. 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed. 4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms.

5. The name of the Consultant / Doctor who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the ENP or responsible doctor, without the request being carried out.

7. The process of ENP requests will be subject to audit.

The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual. 8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.  These are also a requirement of the IR(ME)R.

9. Required Training will consist of a Nurse Practitioner Course, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 3 of 18 2 PROCEDURE FOR RHEUMATOLOGY SPECIALIST NURSE REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of Rheumatology patients, there will, under certain circumstances, be a role for agreed Nurse Practitioners (NP) making requests for radiological examinations.

This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved Rheumatology Specialist NP. An up to date list of referring Specialist NP with specimen signatures should be held by the radiology department or requests will be refused. 2. Requests will be limited to: Hands, Feet, Spine, Pelvis, Shoulder, Upper and Lower Limbs x-ray Hands, Feet and Joint Ultrasound Bone Densitometry Ultrasound guided injection- countersigned by a Consultant Rheumatologist MRI – If discussed and countersigned by Consultant Rheumatologist Nuclear Medicine – if discussed and countersigned by a Consultant Rheumatologist 3. All requests should be completed on a Radiology request card or electronically if available.

Full demographic details of the patient MUST be completed.

4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms, diagnosis (if known) and details of any treatment. 5. The name of the Consultant Rheumatologist who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor.

6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the Nurse Practitioner or responsible doctor, without the request being carried out.

7. The process of Nurse Practitioner requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual.

8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.  These are also a requirement of the IR(ME)R. 9. Required Training will consist of a Nurse Practitioner Course, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 4 of 18 3 PROCEDURE FOR SPECIALIST PHYSIOTHERAPISTS REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of Physiotherapy patients, there will, under certain circumstances, be a role for agreed Specialist Physiotherapists making requests for radiological examinations.

This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R). 1. This access will be limited to approved Physiotherapy Specialist practitioners. An up to date list of referring Physiotherapy Specialist practitioners with specimen signatures should be held by the radiology department or requests will be refused. 2. Requests will be limited to: Spine, Pelvis, Shoulder, Thoracic cage, Upper and Lower limb x-ray Musculo-skeletal and spine MRI following the Radiology MRI training with annual updates Musculo-skeletal Ultrasound – If discussed with an Orthopaedic surgeon / Radiologist CT, Nuclear Medicine,– If discussed and countersigned by an Orthopaedic Surgeon.

. Fluoroscopic guided injections: Hip- If Arthroplasty is planned to be discussed with Orthopaedic surgeon Shoulder Capsule – Ultrasound required prior to injection to rule out Rotator cuff tear Elbow, Ankle, Foot – metal work is relative contraindication discuss with Orthopaedic surgeon Sacroiliacs / Pubis – MRI recommended prior to injection Facet - discuss with Orthopaedic surgeon 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed.

4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms. 5. The name of the Consultant who the patients care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the responsible doctor, without the request being carried out.

7. The process of Specialist Physiotherapy practitioner requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual. 8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 5 of 18  These are also a requirement of the IR(ME)R. 9. Required Training will consist of evidence of post graduate courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 6 of 18 4 PROCEDURE FOR HOSPITAL AT NIGHT NURSE PRACTITIONER (NP) REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of In-patients, there will, under certain circumstances, be a role for agreed Nurse Practitioners making requests for radiological examinations.

This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved Advanced NP. An up to date list of referring advanced nurse practitioners with specimen signatures should be held by the radiology department or requests will be refused. 2. Requests will be limited to: Chest x-ray 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed. 4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms.

5. The name of the Consultant who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request.

This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the Nurse Practitioner or responsible doctor, without the request being carried out. 7. The process of Nurse Practitioner requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual.

8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.  These are also a requirement of the IR(ME)R. 9. Required Training will consist of a Nurse Practitioner Course, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 7 of 18 5 PROCEDURE FOR HEALTH PROTECTION NURSE PRACTITIONER in TB REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of patients, there will, under certain circumstances, be a role for agreed Nurse Practitioners (NP) making requests for radiological examinations.

This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved Health Protection NP’s. An up to date list of referring Health Protection NP’s with specimen signatures should be held by the Radiology department or requests will be refused. 2. Requests will be limited to: Chest x-ray in accordance with NICE Tuberculosis Guidelines 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed. 4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms.

5. The name of the Consultant who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the responsible doctor, without the request being carried out.

7. The process of Nurse Practitioner requests will be subject to audit.

The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual. 8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.  These are also a requirement of the IR(ME)R.

9. Required Training will consist of a Nurse Practitioner Course, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 8 of 18 6 PROCEDURE FOR PAEDIATRIC NURSE PRACTITIONER (PNP) REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of paediatric patients, there will, under certain circumstances, be a role for agreed PNP making requests for radiological examinations.

This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved PNP’s. An up to date list of referring PNP’s with specimen signatures should be held by the Radiology department or requests will be refused. 2. Requests will be limited to: Chest x-ray Renal Ultrasound DMSA and MCUG – requests to be discussed and countersigned by a Consultant Paediatrician.

3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed. 4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms. 5. The name of the Consultant who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor.

6. If the radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the PNP or responsible doctor, without the request being carried out. 7. The process of PNP requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual.

8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.

 It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.  These are also a requirement of the IR(ME)R. 9. Required Training will consist of a PNP Course, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 9 of 18 7 PROCEDURE FOR SPECIALIST PODIATRIST REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of Podiatry patients, there will, under certain circumstances, be a role for agreed Specialist Podiatrists making requests for radiological examinations. This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved Podiatry Specialist practitioners. An up to date list of referring Podiatry Specialist practitioners with specimen signatures should be held by the Radiology department or requests will be refused. 2. Requests will be limited to: Feet, Toes, Ankle, Knee and pelvis x-ray Foot Ultrasound following Ultrasound training and authorisation by Radiology. 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed.

4. A full clinical history should be given with each request.

This should include the results of clinical examination and clear explanation of signs and symptoms. 5. The name of the Doctor who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the responsible doctor, without the request being carried out.

7. The process of Specialist Podiatrist practitioner requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual. 8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.

 These are also a requirement of the IR(ME)R. 9. Required Training will consist of an MSc module in Diagnostic Imaging, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 10 of 18 8 PROCEDURE FOR GP NURSE PRACTITIONERS (NP) REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of GP patients, there will, under certain circumstances, be a role for some agreed GP NP making requests for radiological examinations.

This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved NP’s. An up to date list of referring NP’s with specimen signatures should be held by the Radiology department or requests will be refused. 2. Requests will be limited to: Chest x-ray 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed.

4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms. 5. The name of the GP who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the responsible doctor, without the request being carried out.

7. The process of GP NP requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual. 8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.

 These are also a requirement of the IR(ME)R. 9. Required Training will consist of evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 11 of 18 9 PROCEDURE FOR NON MEDICAL PROFESSIONALS REQUESTING BONE DENSITOMETRY EXAMINATIONS As an aid to the efficient management of patients, there will, under certain circumstances, be a role for agreed Non Medical Professionals (NMP) making requests for DXA examinations. This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved NMP’s. An up to date list of referring NMP with specimen signatures should be held by the radiology department or requests will be refused. 2. Requests will be limited to: Bone Densitometry 1. All requests should be completed on a DXA request form or electronically if available. Full demographic details of the patient MUST be completed. 2. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms.

3. The name of the GP/ Consultant who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request.

This is a legal requirement and will also facilitate any clinical discussion between Rheumatologist / reporting Radiographer and responsible doctor. 4. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the responsible doctor, without the request being carried out.

5. The process of NMP requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual. 6. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.

 These are also a requirement of the IR(ME)R. 9. Required Training will consist of a Course providing relevant understanding to make assessment in relation to factors indicating Osteoporosis or Osteopoenia, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 12 of 18 10 PROCEDURE FOR NEONATAL NURSE PRACTITIONER (NNP) REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of paediatric patients, there will, under certain circumstances, be a role for agreed NNP’s making requests for radiological examinations. This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved NNP’s. An up to date list of referring NNP’s with specimen signatures should be held by the radiology department or requests will be refused. 2. Requests will be limited to: In concordance with the Advanced Neonatal NP protocol Chest, Abdomen, Skull, Upper and Lower Limb x-rays Abdominal, Renal and Cranial Ultrasound 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed.

4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms.

5. The name of the Consultant who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the NNP or responsible doctor, without the request being carried out.

7. The process of NNP requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual. 8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.

 These are also a requirement of the IR(ME)R. 9. Required Training will consist of a NNP Course, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 13 of 18 11 PROCEDURE FOR RADIOGRAPHERS REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of patients, there will, under certain circumstances, be a role for agreed Radiographers making requests for radiological examinations.

This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved Radiographers. An up to date list of referring Radiographers with specimen signatures should be held by the Radiology department or requests will be refused. 2. Requests will be limited to: Nuclear Medicine Radiographers – • Plain film of any area noted as a ‘hot spot’ on a Bone scan, provided there are not multiple areas, or a plain film / MRI / CT of that area has not taken place within a month prior.

• Prostate scan, Plain film pelvis if not already performed. • VQ lung scan, Chest x-ray if not already performed within 24hours prior. MRI Radiographers -X-rays for patients, who have indicated in the safety questionnaire that they have a metal foreign body or implant as per MHRA guidelines and if no x-rays of the relevant area have previously been undertaken. 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed.

4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms.

5. The name of the Consultant who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back without the request being carried out.

7. The process of Radiographer requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual 8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.

 These are also a requirement of the IR(ME)R. 9. Required Training will consist of a Radiography degree or equivalent, and evidence of further

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 14 of 18 courses related to the area of specialisation. 12 PROCEDURE FOR THE ACUTE MEDICAL AND SURGICAL NURSE PRACTITIONERS (NP) REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of acute medical and surgical patients, there will, under certain circumstances, be a role for agreed NP’s making requests for radiological examinations.

This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved Acute Medical and Surgical NP’s. An up to date list of referring NP’s with specimen signatures should be held by the Radiology department or requests will be refused. 2. Requests will be limited to: Chest x-ray 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed. 4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms.

5. The name of the Doctor who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request.

This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the nurse practitioner or responsible doctor, without the request being carried out. 7. The process of NP requests will be subject to audit. The results of the audit will be shared with the referrer and their manager If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual.

8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.  These are also a requirement of the IR(ME)R. 9. Required Training will consist of a Nurse Practitioner Course, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 15 of 18 13 PROCEDURE FOR ORTHOPAEDIC PAEDIATRIC SPECIALIST PHYSIOTHERAPIST REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of Orthopaedic paediatric patients, there will, under certain circumstances, be a role for agreed Specialist Physiotherapists making requests for radiological examinations.

This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R). 1. This access will be limited to approved Specialist Physiotherapists. An up to date list of referring Specialist Physiotherapists with specimen signatures should be held by the Radiology department or requests will be refused. 2. Requests will be limited to: Plain film will be allowed in the following suspected clinical conditions if no previous imaging or xrays.

Pelvis: Slipped upper femoral epiphysis, Perthes disease Spine: Scoliosis Knee: Osteochondrondritis or Osteochondral effects Ankle and Feet: Suspected tarsal coalition Ultrasound for ganglion or popliteal cyst and inflammatory knee conditions only MRI appendicular and axial must be countersigned by the Consultant.

If previous imaging is available then discussion with a consultant will be required to support the referral. In all other pathologies, discussion with a consultant will be required as a better modality may be available. E.g Ultrasound for Osgood Schlatter's, Ultrasound for joint effusions, MRI for low back pain etc 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed.

4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms. 5. The name of the Doctor who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the Physiotherapist or responsible doctor, without the request being carried out.

7. The process Specialist Physiotherapist requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual.

8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 16 of 18  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.

 These are also a requirement of the IR(ME)R. 9. Required Training will consist of a Specialist Physiotherapist Course, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 17 of 18 14. PROCEDURE FOR CARDIOLOGY NURSE PRACTITIONERS (NP) REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of minor Cardiology patients, there will, under certain circumstances, be a role for agreed NP’s making requests for radiological examinations. This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).

1. This access will be limited to approved Cardiology NP’s. An up to date list of referring Cardiology NP’s with specimen signatures should be held by the Radiology department or requests will be refused. 2. Requests will be limited to: Chest x-ray for acute cardiology presentations 3. All requests should be completed on a Radiology request card or electronically if available. Full demographic details of the patient MUST be completed. 4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms.

5. The name of the Doctor who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the Nurse Practitioner or responsible doctor, without the request being carried out. 7. The process of NP requests will be subject to audit.

The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual.

8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.  These are also a requirement of the IR(ME)R. 9. Required Training will consist of a Nurse Practitioner Course, and evidence of further courses related to the area of specialisation.

NHS Fife Policy for Requesting Radiological Investigations by Non- Medical Healthcare Professionals NHS Fife is committed to the provision of a service that is fair, accessible and meets the needs of all individuals Policy No.: R2 Review Date:20/10/2012 Page 18 of 18 15.

PROCEDURE FOR UPPER GI NURSE PRACTITIONERS (NP) REQUESTING OF RADIOLOGICAL EXAMINATIONS As an aid to the efficient management of patients, there will, under certain circumstances, be a role for agreed NP’s making requests for radiological examinations.

This protocol complies with the policies and procedures for NHS Fife’s Radiology Directorate and Ionising Radiation (Medical Exposure) Regulations (IR(ME)R). 1. This access will be limited to approved GI NP’s. An up to date list of referring GI NP’s with specimen signatures should be held by the Radiology department or requests will be refused. 2. Requests will be limited to: Patients with either positive histological diagnosis or the Nurse Practitioner has performed the Endoscopy examination and biopsy CT Chest / Abdomen 3. All requests should be completed on a Radiology request card or electronically if available.

Full demographic details of the patient MUST be completed.

4. A full clinical history should be given with each request. This should include the results of clinical examination and clear explanation of signs and symptoms. 5. The name of the Doctor who the patient’s care is under and on whose behalf the request is being made should be clearly indicated on the request. This is a legal requirement and will also facilitate any clinical discussion between Radiologist/reporting Radiographer and responsible doctor. 6. If the Radiographer carrying out the examination has any doubts about whether the request is justified, he/she is legally obliged by the IR(ME)R to query it and may refer it back to the Nurse Practitioner or responsible doctor, without the request being carried out.

7. The process of NP requests will be subject to audit. The results of the audit will be shared with the referrer and their manager. If the quality of requests from an individual is persistently deficient, the Radiology Directorate reserve the right not to accept requests from that individual.

8. The Medico-legal position:-  No investigation should be requested unless it can be clinically justified and its result is likely to influence patient management.  It is essential to check whether the examination has already been performed and to ensure that unnecessary repeat examinations are not carried out.  These are also a requirement of the IR(ME)R. 9. Required Training will consist of a Nurse Practitioner Course, and evidence of further courses related to the area of specialisation.

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