CLINICAL IMAGING REFERRAL PROTOCOL FOR REGISTERED NURSE PRACTITIONERS IN THE EMERGENCY DEPARTMENT, URGENT CARE CENTRE AND AMBULATORY CARE

Transcription

1 CLINICAL IMAGING REFERRAL PROTOCOL FOR REGISTERED NURSE PRACTITIONERS IN THE EMERGENCY DEPARTMENT, URGENT CARE CENTRE AND AMBULATORY CARE CLINICAL GUIDELINE V4.

2 Summary. Start The non-medical practitioner has received sufficient training to make clinical referrals within their speciality The non-medical referrer has received the correct imaging training requirements IR(ME)R Imaging QSI Lead authorises referral entitlement and maxims access No Referral is within the NMR scope of practice outlined in section 2.4 Yes Discuss with responsible medical practitioner or a consultant radiologist before proceeding. Further examinations must be made by the medical practitioner/consultant. Imaging not required Imaging required Referral for imaging procedure requested on maxims End Clinical imaging department acquires analyses and reports the diagnostic images. The non-medical referrer is responsible for checking the radiology report and acting on the finding appropriately and documenting actions and outcomes within the clinical care/patient record End Page 2 of 13

3 1. Aim/Purpose of this Guideline This Protocol applies to Registered Nurse Practitioners in the Emergency Department in the Royal Cornwall Hospital and the Urgent Care Centre at West Cornwall Hospital who are undertaking the role of referrer under the Ionising Radiation (Medical Exposure) Regulations 2017, IR(ME)R17. Referrer, in the context of this protocol the term referrer refers to a health care worker who is authorised to refer individuals for X-rays. The purpose of this protocol is to authorise appropriately qualified non-medical practitioners to request specified x-rays examinations, adhering to the Ionising Radiation Regulations IR (ME)R and the Royal College of Radiologist Guidelines 2. The Guidance 2.1. Responsibilities The non-medical practitioner in acting as referrer must do so in accordance with IR(ME)R and the RCHT Radiation Safety Policy. The non-medical practitioner must have received sufficient training and be assessed as competent to make clinical imaging referrals. The non-medical practitioner s clinical supervisor and the Radiation Protection Advisor (RPA) are responsible for ensuring that the appropriate training has been undertaken Class of Healthcare Professional and Approved Clinical Area Registered Nurses operating within Emergency Department, and Ambulatory Care in the Royal Cornwall Hospital and the Urgent Care Centre at West Cornwall Hospital 2.3. Training and Education This protocol applies to Registered Nurse Practitioners in the Emergency Department and Ambulatory Care in the Royal Cornwall Hospital and the Urgent Care Centre at West Cornwall Hospital, who are competent to examine and assess patients for clinical imaging. All practitioners must have completed: Specific training and education in clinical assessment of the anatomical sites stated in this protocol Healthcare Practitioners with the appropriate level of qualification, which must have included the Plymouth University Accredited Module in Minor Injuries skills and practice (NURB261) or equivalent qualification. The Practitioner must be deemed competent at level 5 of the relevant competency within the module key skills book or equivalent qualification. All practitioners must have completed IR(ME)R training. A list of authorised referrers will be retained by the Emergency and Casualty Departments and the Clinical Imaging Department. Royal Cornwall Hospital and the Urgent Care Centre in West Cornwall Hospital V4.0 Page 3 of 13

4 2.4. Description of the Procedures to which the Protocol Applies X-rays of the upper limb, from fingers to the clavicle. X-rays of the lower limb, from the toes up to, and including, the knees. X-rays to determine the presence of a foreign body( with the exception of coins) X-rays may be requested for children aged 2 years and over in accordance with where the nurse believes the injury to be uncomplicated (no neuro/vascular complications). AP pelvis/lateral hip in case of suspected fracture neck of femur, dislocated hip or periprosthetic fracture. Femur for suspected fracture/trauma. OPG/Facial bones X-rays where imaging facilities allow. The Registered Nurse may also request the following examinations. The request and review of the image must be documented on the medical proforma. CXRs with a clinical indication of: Chest Pain Shortness of Breath Suspected PE (pleuritic chest pain/breathlessness with no previous lung disease) Falls/Collapse Confusion Chest Infection Haematemesis Stroke/TIA Unexplained loss of consciousness 2.5. Referral Process and Excluded Areas. The clinical information must state clinical history, clinical findings, potential diagnosis and the specific area and side to be examined. If the Registered Nurse is in doubt as to whether an investigation is required or which is most appropriate, they will discuss the case with the responsible medical practitioner or a Consultant radiologist prior to requesting. The Registered Nurse will be informed of any significant radiological findings. The Registered Nurse will be responsible for checking the radiology report and acting on the findings appropriately. In the case of an unexpected adverse finding the Registered Nurse will discuss this with the responsible medical practitioner. Royal Cornwall Hospital and the Urgent Care Centre in West Cornwall Hospital V4.0 Page 4 of 13

5 Excluded Areas All examinations and patient groups not defined within this protocol. The non-medical practitioner must not operate under this protocol in clinical areas not specified with section Skull x-rays Spine and abdomen Injury should not be more than 14 days old. The clinical information we will require will consist of mechanism of injury, clinical findings, potential diagnosis and the specific area for which the x-ray, i.e. wrist, ankle, foot, is requested. Do not request views such as lateral projections or oblique projections. An appropriately qualified practitioner will view all x-rays before treatment or discharge. All findings and treatment will be clearly documented by the health care practitioner on the patient s casualty card. Under this protocol, chest X-rays can only be requested. A medical practitioner must interpret the image and document in the patient s notes Excluded Patients Children under 2 years of age Patients who are, or may be, pregnant 2.6. Patients who are, or may be, pregnant. If an X-ray examination is deemed necessary due to overriding clinical reasons in a patient who is or may be pregnant the referral must be made by a Doctor Unexpected & Adverse Findings The Clinical Imaging Department is responsible for acquiring, analysing and reporting of diagnostic images, to enable Emergency Nurse Practitioners to make an informed clinical decision. In the case of unexpected or adverse findings including those outside of the practitioner s scope of practice, the professional and clinical responsibility to act on the information appropriately remains with the Emergency Nurse Practitioner. The Emergency Nurse Practitioner must discuss the findings with the medical practitioner who holds overall responsibility for the patient i.e. Consultant/ General Practitioner immediately Documentation All documentation will be in compliance with the Department of Clinical Imaging requirements and the RCHT Standards of Record Keeping. It is a requirement of the Clinical Imaging Department that all non-medical referrers document their job title on the request; failure to do so may result in the examination being declined. Page 5 of 13

6 2.9. Continuing Professional Development As a result of ongoing audit any Registered Nurse currently requesting x-rays falling below the agreed standard in terms of inappropriateness of requesting will be withdrawn from the scheme and further training given until the required standard is met. Each Registered Nurse is responsible for maintaining their professional development Accredited and authorized Healthcare Practitioners Names of referrers are kept on a secure electronic database. All specimen signatures are found on the IR(ME)R Entitlement Referrer Form and held by Clinical Imaging. All names will be added to the IR(ME)R referrer database also held by clinical imaging. 3. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared Requesting within the scope of this protocol Imaging Quality and Service Improvement Lead Monitor imaging requests made through the hospital ordercomms system. All non-medical referrers working within this protocol will be audited annually to ensure requesting is within scope of practice dictated by this protocol. Referrals requested will be checked on ordercomms (maxims) over a three month period, those referrers who are not requesting correctly will be investigated further by looking retrospectively at the previous 12 months referrals. Audits will be reported to the Clinical Imaging Governance group, which meets on a monthly basis. Minutes of the meeting will record decisions and actions; these are produced by the Imaging PACS team. Audits will be reported to the Clinical Imaging Governance group, which meets on a monthly basis. Minutes of the meeting will record decisions and actions; these are produced by the Imaging PACS team. Any recommendations will be communicated to the referrer and their supervisor immediately. Discussed and communicated from CICG. Page 6 of 13

7 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 7 of 13

8 Appendix 1. Governance Information Document Title Date Issued/Approved: Clinical Imaging Referral Protocol For Registered Nurse Practitioners in the Emergency Department and Ambulatory Care Unit in the Royal Cornwall Hospital and the Urgent Care Centre in West Cornwall Hospital V4.0 Date Valid From: Date Valid To: Directorate / Department responsible (author/owner): CSCS / Clinical Imaging Glenda Shaw Imaging QSI Lead Contact details: Brief summary of contents Protocol to enable non-medical requesters within ED, Ambulatory Care and Urgent care to request clinical imaging Suggested Keywords: Target Audience Executive Director responsible for Policy: Non-medical referrer imaging RCHT CPFT KCCG Medical Director Date revised: This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Clinical Imaging Referral Protocol For Registered Nurse Practitioners in the Emergency Department and Ambulatory Care Unit in the Royal Cornwall Hospital and the Urgent Care Centre in West Cornwall Hospital V3.0 Clinical Imaging Governance Committee (CICG) GovDMB Associate Director CSCS Name and Post Title of additional signatories Name and Signature of Divisional/Directorate Governance Diagnostic Imaging Lead Divisional Governance Lead {Original Copy Signed} Page 8 of 13

9 Lead confirming approval by specialty and divisional management meetings Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Related Documents: Training Need Identified? Name: {Original Copy Signed} Internet & Intranet Clinical / Clinical Imaging Intranet Only Ionising radiation (Medical Exposure) Regulations RCHT Patient Identification Policy RCHT Consent to Treatment/Examination RCHT Standards of record keeping RCHT Radiation safety Policy No Version Control Table Date Version No Summary of Changes Changes Made by (Name and Job Title) July Document created S. Bromage June 2011 July Document re-formatted and updated. 3.0 Foreign Bodies included, reformat and updated to reflect urgent care centre, WCH and ambulatory care. N. Burden Governance Radiographer N. Burden Governance Radiographer March Removal of appendix 1. Document reformatted and updated. Amendments following NMR audit and Review Glenda Shaw Image Quality & service improvement lead A&E Matrons A&E Jonathan Wyatt ED Consultant/Glenda Shaw Imaging QSI Lead. Page 9 of 13

10 All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 10 of 13

11 Appendix 2. Initial Equality Impact Assessment Form This assessment will need to be completed in stages to allow for adequate consultation with the relevant groups. Name of Name of the strategy / policy /proposal / service function to be assessed Clinical Imaging Referral Protocol For Registered Nurse Practitioners in the Emergency Department and Ambulatory Care Unit in the Royal Cornwall Hospital and the Urgent Care Centre in West Cornwall Hospital V4.0 Directorate and service area: Is this a new or existing Policy? CSCS/ Clinical Imaging Existing Name of individual completing assessment: Glenda Shaw Telephone: Policy Aim* To authorize appropriately qualified non-medical practitioners to request specified X-ray examinations, adhering to the ionising radiation Regulations IR(ME)R and the Royal College of radiologists guidelines 2. Policy Objectives* To enable appropriately trained (job title) to request the specified X- Ray examinations. 3. Policy intended Outcomes* To ensure that X-Ray referrals are made by an appropriately trained practitioner and within a specific remit. 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a Who did you consult with b). Please identify the groups who have been consulted about this procedure. What was the outcome of the consultation? Patients through prompt assessment and appropriate referral as appropriate. Patients through prompt assessment and appropriate referral as appropriate. Workforce Patients Local groups Please record specific names of groups External organisations Other Page 11 of 13

12 7. The Impact Please complete the following table. If you are unsure/don t know if there is a negative impact you need to repeat the consultation step. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Unsure Rationale for Assessment / Existing Evidence Age Sex (male, female, trans-gender / gender reassignment) Race / Ethnic communities /groups Disability - Learning disability, physical impairment, sensory impairment, mental health conditions and some long term health conditions. Religion / other beliefs Marriage and Civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major this relates to service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Glenda Shaw Date of completion and submission Page 12 of 13

13 Names and signatures of members carrying out the Screening Assessment 1. Glenda Shaw 2. Human Rights, Equality & Inclusion Lead Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD This EIA will not be uploaded to the Trust website without the signature of the Human Rights, Equality & Inclusion Lead. A summary of the results will be published on the Trust s web site. Signed Glenda Shaw Date Page 13 of 13