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

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


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

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

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

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

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



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

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


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

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

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.




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
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