POLICY ON NURSE PRESCRIBING OF MEDICAL IONISING RADIATION 1 Versin Number V1 Date f Issue July 2016 Reference Number Review Interval Apprved By Name: Dr. Rachel Byrne Title: Cnsultant Radilgist Authrised By Name: Rachel Kenna Title: Directr f Nursing Name: Sean Walsh Title: Medical Directr Name: Helen Shrtt Title: Chief Executive Officer Authr Name: Finnuala O Neill Title: Nurse Practice Crdinatr Lcatin f Cpies PNPMIR-07-2016-FON-V1 Yearly fr the first review & then tw yearly unless changes in legislatin and practice suggest a mre frequent review Signature: Date: July 2016 Signature: Date: July 2016 Signature: Date: July 2016 On Hspital Intranet and lcally in department Dcument Review Histry Review Date Reviewed By Signature 2019 Dcument Change Histry Change t Dcument Reasn fr Change 1 https://www.hse.ie/eng/abut/wh/onmsd/practicedevelpment/xrayprescribing/guidingframewrkx-rayprescribing.pdf
Date f Issue: March 2016 Page 2 f 12 CONTENTS Page Number 1.0 Intrductin 3 2.0 Definitin f Guideline 3 3.0 Applicable t 3 4.0 Rles & Respnsibilities 3 5.0 Objectives f the Plicy 4 6.0 Definitins / Terms 4 7.0 Prcesses 4 8.0 Implementatin Plan 4 9.0 Evaluatin and Audit 5 10.0 References 5 11.0 Bibligraphy (as necessary) 5 12.0 Appendices (as necessary) 5
Date f Issue: March 2016 Page 3 f 12 1.0 Intrductin The plicy fr nurse prescribing inising radiatin (X-Ray), must be develped within the legislative and regulatry framewrk and any cnditins determined by the health service prvider. It shuld be stated that the plicy must be read in cnjunctin with the legislatin, regulatin, rules and the An Brd Altranais guidance dcuments listed belw. 1.2 Legislatin and Prfessinal Regulatin Irish Law was amended in 2007, t allw the pprtunity fr nurses t expand their scpe f practice t include authrity t prescribe medical inising radiatin (X-Ray). The Statutry Instrument (SI) N. 303 f 2007 amended SI N.478 f 2002 Eurpean Cmmunities (Medicinal Inising Radiatin Prtectin) Regulatins 2002. The S.I incrprated an amendment t the previus definitin f prescriber t included nurses as prescribers f inising radiatin (X-Ray). S.I N. 303 Eurpean Cmmunities (Medical Inising Radiatin Prtectin (Amendment) Regulatin 2007 states that: (d) A persn whse name is entered n the register f nurses as maintained by An Brd Altranais established by the Nurses Act 1985 and wh meets the standards and requirements set dwn by An Bard Altranais frm time t time t allw them t refer individuals fr medical expsures t a practitiner. 1.3 Prfessinal Regulatin (Nursing) An Brd Altranais (ABA), is the statutry regulatry bdy fr Nurses and Midwives in Ireland. Fllwing cnsultatin with the Faculty f Radilgists, ABA published the Requirements and Standards fr Nurse Educatin Prgrammes fr Authrity t Prescribe Inising Radiatin (X-Ray) (An Bard Altranais 2008). The Requirements and Standards dcument utlines the requirements fr the nurse educatin and the apprval prcess fr educatin prviders fr the prvisin f educatin fr authrity t prescribe inising radiatin (X- Ray) in terms f learning utcmes, cmpetencies fr authrity t prescribe inising radiatin, syllabus/indicative cntent, theretical and clinical instructin and scpe f practice fr prescribing inising radiatin. In additin, nurses prescribing inising radiatin (X-Ray) must practice in accrdance with guidance issued by Nursing and Midwifery Bard f Ireland including: Recrding Clinical Practice-Guidance t Nurse and Midwives (2002) The Cde f Prfessinal Cnduct and Ethics fr Nurses and Midwives (201) Review f the Scpe f Nursing and Midwifery (2015)
Date f Issue: March 2016 Page 4 f 12 2.0 Applicable t This plicy is applicable t the fllwing persns / grups in OLCHC: Registered nurses, wh are entered n the divisin f nurse prescribers with An Brd Altranais. Prescribing Site Crdinatr. Divisinal Nurse Managers and Nursing Line Managers. Directr f Nursing. Cnsultant Medical Practitiner/s the medical team/s participating in the Cllabrative Practice Agreement. Medicatin Safety Cmmittee Radiatin Safety Cmmittee Clinical Risk Manager The Pharmacy Department, including ward based clinical pharmacists Drugs and Therapeutics Cmmittee Medical Bard Chief Executive Officer The plicy als affects the fllwing: The child and his / her parent / guardian 3.0 Definitin f Plicy A plicy is a principle that gverns activity and which individuals are expected t fllw. The dcument utlines the plicy f Our Lady s Children s Hspital, Crumlin (OLCHC) in relatin t nurse prescribing f inising radiatin. 4.0 Objectives f Plicy The bjectives f this plicy are: Guidance: T prvide guidance fr the prfessinal practice f registered nurse prescribers (RNP) emplyed with OLCHC. Respnsibility and accuntability: T prvide clear lines f respnsibility, authrity and accuntability t supprt nurse prescribing within OLCHC. Prfessinal and Legislative Respnsibilities: T utline the prfessinal and legislative respnsibilities in relatin t prescribing practices by registered nurse prescribers. Partnership and Cllabratin: T ensure that medicatin needs f the child are met in cllabratin with the multidisciplinary team and in partnership with the child and his/her family. Safety: T supprt the prescribing practice f RNP s, thus ensuring children s safety during the medicatin management prcess.
Date f Issue: March 2016 Page 5 f 12 Purpse f the Plicy The purpse f the plicy, is t intrduce nurse prescribing inising radiatin and develp new ways f wrking, prvide better access and meet the need f the child and family in partnership and cllabratin with the inter and multidisciplinary teams. The aim is t: Link the intrductin f nurse prescribing inising radiatin (X-Ray) t strategic service develpment. Prvide clear guidance underpinned by the legislative and regulatry framewrk and cnditins applied by the health service prvider t allw nurses t prescribe inising radiatin (X-Ray). Cmmit t the principle, that nurse prescribing inising radiatin (X-Ray), must be embedded within a sund, rbust clinical gvernance framewrk, with regular auditing and evaluatin. Prvide clear lines f respnsibility and accuntability t supprt nurses prescribing inising radiatin (X-Ray). Ensure the safety f patients r service users. Highlight best practice supprted by relevant dcuments and plicies, which will supprt nurse prescribers, t maintain and imprve their prescribing cmpetencies, and; Cmmunicate the health care prviders structures and prcesses t supprt nurse prescribing inising radiatin (X-Ray) 5.0 Gvernance f Nurse Prescribing in OLCHC The plicy f OLCHC is t ensure that the implementatin and develpment f nurse prescribing inising radiatin, is situated within a rbust clinical gvernance framewrk. The Senir Nursing Management Team in OLCHC, has utlined the fllwing criteria, which a nurse must meet in rder t be nminated t apply fr a nurse prescribing curse: Emplyed at a grade f CNM2 level r abve 1. Wrking in OLCHC fr ne year minimum 2. 1 These grades include: Advanced Nurse Practitiner (ADON Grade) The Natinal Cuncil fr Nursing & Midwifery, stipulate that these nurses have a dual reprting relatinship t the Directr f Nursing and t the Cnsultant. Clinical Nurse Specialists (CNM2 Grade) The Natinal Cuncil fr Nursing & Midwifery, stipulate that these nurses have a reprting relatinship t the Divisinal Nurse Manager and liaise with the children s lead Cnsultant.
Date f Issue: March 2016 Page 6 f 12 Within the cntext f a Cllabrative Practice Agreement the Registered Nurse Prescriber, will have a reprting relatinship with the respnsible Cnsultant. 2 This des nt relate t nurses, wh are appinted frm anther hspital and wh may already have undertaken a nurse prescribing curse. This will require negtiatin with the Directr f Nursing and the Cnsultants within the area. 6.0 Definitins Cmpetence the ability f the registered nurse t practice safely and effectively fulfilling her / her prfessinal respnsibility within her / his scpe f practice (Review f Scpe f Practice fr Nursing and Midwifery, An Bard Altranais, 2000b). Nurse A wman r man, whse name is entered in the An Bard Altranais register and includes a midwife and nursing (Nurses Act 1985). Inising Radiatin Radiatin that prduces inizatin in matter. Examples are alpha particle, gamma rays, x-rays and neutrns. When these radiatins pass thrugh the tissues f the bdy, they have sufficient energy t damage DNA. (Health Prtectin Agency 2009) X-Ray A discrete quantity f electrmagnetic energy withut mass r change. machine. (Health Prtectin Agency 2009) Emitted by an X-Ray 4.0 Objective f the Guidelines Implementatin Grup The rles f the lcal Implementatin Grup has respnsibility t: Identify suitable clinical areas fr the intrductin f nurses, prescribing f medical inising radiatin (X- Ray) in the lcal health services. Implement plicies, prtcls, guidelines t supprt the practice change. Ensure rbust clinical cmpetency assessment systems are in place. Establish a link t the database f nurses prescribing inising radiatin (X-Ray) in each hspital. Mnitr impact f the change in practice n radilgy services. Ensure risk management structures are in place. Review any unexpected incidents r events. Ensure audit systems and feedback mechanisms are in place including feedback / learning mechanisms. Oversee evaluatin prcess f all aspects f the change. Reprt t Radiatin Safety Cmmittee.
Date f Issue: March 2016 Page 7 f 12 The Directr will sign the nurse prescribing inising radiatin (X-Ray) Declaratin Frm, n behalf f the health service prvider and in ding s, cmmits t ensuring that the fllwing structures are in place t supprt nurses prescribing inising radiatin (X-Ray): Selectin f prescribers Ensure that all entrants t the prescribing f the inising radiatin (X-Ray) educatin prgramme, are selected accrding t criteria, indicating their ptential t prescribe safely in the area which they will practice. Authrisatin t cmmence prescribing Authrises nurses, wh have successfully cmpleted the educatin prgramme t be entered n the natinal database and t cmmence prescribing inising radiatin (X-Ray). Safe Management - Ensures an rganisatin plicy fr nurse prescribing inising radiatin (X-Ray), is in place, as is the ability t safely manage and quality assure prescribing practices. Risk management systems, must als be in place and prcesses fr adverse event reprting. Educatin and Practice Develpment - Includes apprpriate Clinical Supervisr arrangements and cmmitment t cntinuing educatin fr staff supprt the prescribing initiative. C-rdinatin - A named individual with respnsibility fr the initiative lcally and fr liaisn with the educatin prvider, An Brd Altranais and the HSE Offices f the Nursing Services Directr. Cmmitment t cmply with and ensure data input fr the Nurse Prescribing Inising Radiatin (X-Ray) Data Cllectin System. Access t a cmputer, email and internet fr data input t the Nurse Prescribing Inising Radiatin (X-Ray) Data Cllectin Systems. Audit and Evaluatin - A mechanism t audit the Nurse Prescribing Inising Radiatin (X-Ray) practices. Final apprval prcess - Once all the structures, prcess, plicies and prcedures are established t supprt Nurse Prescribing Inising Radiatin (X-Ray) in accrdance with the legislative and regulatry framewrk, the Directr f Nursing, n behalf f the health service prvider [name rganisatin] must be given the final apprval and enter the nurse prescriber n t the natinal database, thus authrising the nurse t cmmence inising radiatin (X-Ray) in the health service setting. 4.1 Nurse Manager f the Nurse Prescriber (X-Ray) Detail the respnsibilities f the relevant nurse manager within the health care setting fr Nurse Prescribing Inising Radiatin (X-Ray) Detail the respnsibilities f the nurse line manager, in relatin t Nurse Prescriber Inising Radiatin (X-Ray), wrking within their area f respnsibility. Details respnsibilities in relatin t audit, such as receiving, interpreting and respnding apprpriately t audit reprts cnducted by the Nurse Prescribing Inising Radiatin (X-Ray). This may include:
Date f Issue: March 2016 Page 8 f 12 Crdinating the develpment, implementatin, mnitring and evaluatin f the structures and prcesses t supprt sage Nurse Prescribing Inising Radiatin (X-Ray) and ensuring its cmpliance with the requirements and standards f An Bard Altranais and the Health Service Executive. Activing as a central pint f cntact fr the Nurse Prescribing Inising Radiatin (X-Ray), fr clinical supervisrs, medical practitiners and key stakehlders in rder t cmmunicate regarding the Nurse Prescribing Inising Radiatin (X-Ray) initiative. Liaising with nurses, bth undertaking educatinal preparatin and thse authrised t prescribe inising radiatin (X-Ray), the Lcal Implementatin Grup risk management, radilgy departments and all ther relevant stakehlder. Facilitating nurses prescribing inising radiatin (X-Ray within the health service prvider t meet their respnsibilities t ensure safe and effective prescribing). Supprting the implementatin f the mnitring, audit and the evaluatin prcesses fr nurses authrised t prescribe prescribing inising radiatin (X-Ray). Overseeing the mnitring, audit and evaluatin f prescribing inising radiatin (X-Ray) in line with the health service prviders audit plicy; and Prviding reprts n the develpment, intrductin, mnitring and evaluatin f Nurse Prescribing Inising Radiatin (X-Ray) the health service prvider. 4.2 Respnsibilities f the Clinical Supervisr It is the respnsibility f the clinical supervisr t: Prvide supprt, teaching and learning pprtunities in the clinical practicum. Facilitate learning by encuraging critical thinking and reflectin. Prvide dedicated time and pprtunities fr the nurse t cnduct a full episde f care, t include prescribing inising radiatin (X-Ray). Ensure the nurse integrates thery with practice. Verify and dcument all supervised practice fr the duratin f the prgramme. Meet frmally t review prgress. Frmally assess the nurses cmpetence in the clinical practicum, using the Assessment Tl fr Assessing Clinical Cmpetence (Episde 5 and Episde 10). Dcument that the nurse is cmpetent r nt cmpetent (Appendix 10). Cllabrate with the Prgramme Crdinatr, t ensure adequate supprt fr the nurse in the clinical practicum. Sign the Nurse Prescribing f Medical Inising Radiatin Declaratin Frm (Appendix 7), t cnfirm his / his cmmitment t the prcess.
Date f Issue: March 2016 Page 9 f 12 The clinical supervisr has n further rle, fllwing the nurses cmpletin f the educatin prgramme. 4.3 Nurse Undertaking Educatin Prgramme When undertaking the educatin prgramme the nurse will: Successfully cmplete the Certificate Nurse Prescribing Inising Radiatin (X-Ray); Ensure that the theretical and clinical experience requirements and assessments are cmpleted within the required timeframe; Discusses with the Directr / Prescribing Site Crdinatr, any situatins where these respnsibilities cannt r are nt being fulfilled; and Present evidence f successful cmplete f the prgramme t the Directr f Nursing. 4.4 Nurse Authrised t Prescribe Inising Radiatin (X-Ray) The Nurse with Authrity t Prescribe Inising Radiatin (X-Ray) Is respnsible fr the assessment fr the patient / service user, determining what the prblem is and making a diagnsis that may lead t a clinical decisin t prescribe inising radiatin (X-Ray). The Registered Nurse Prescriber, hlds full accuntability and respnsibility fr this prcess / actin. Ensure their name is entered in HSE natinal database. Practice in cmpliance with all f the relevant statutry prvisins, An Bard Altranais guidelines and all lcal guidelines and cnditins. Prescribes fr patient / service user ppulatins within the practice setting and scpe f practice set ut in their lcal plicy. Inputs infrmatin fr the Natinal Nurse Prescribing Inising Radiatin (X-Ray) Minimum Data Set n all prescriptins written in the Nurse Prescribing Inising (X-Ray) Data Cllectin System and furnishes statistical reprts as required. Cmmits t and undertakes cntinuing prfessinal develpment t maintain their cmpetence fr prescriptive authrity. Infrms the Directr r Line Manager f any cncerns pertaining t their cmpetence.
Date f Issue: March 2016 Page 10 f 12 Cnducts audits f prescribing inising radiatin (X-Ray) practice and furnishes reprts as required. Wrks cllabratively with ther members f the healthcare team, in rder t enhance therapeutic utcmes fr patients / service users. Acts as an educated advisr t ther students undertaking the Certificate in Nursing (Nurse Prescribing Inising Radiatin (X-Ray)) Maintains nging cmmunicatin and cllabratin with members f the health care team including cllabrating medical practitiners and the radilgy departments. Discusses with the Directr f Nursing r designate any situatins where these respnsibilities cannt r are nt being fulfilled. 5.0 Indemnity Cnsider including the statement n the cver prvided by the State Claims Agency (CIS) see belw extract frm the State Claims Agency Statement (20 th April 2009) (Appendix 4). 6.0 Prcedure 6.1 Verificatin f Prescribing Status Details prcesses in place fr key stakehlders within the utside health care setting t verify prescribing status f the nurse authrised t prescribe inising radiatin (X-Ray). 6.2 Gd Prescribing Practice Detail the arrangements fr the fllwing practice: Respnsibility fr prescribing decisins. Mandatry Patient / Service User and Prescriber details Legibility. The user Ryal Cllege f Radilgy Referral Guidelines; and Patient referral and fllw up pathway (Plicy Annexe 2) 6.3 Reprting f near misses and adverse drug reactins Detail the prcess within the health care setting fr reprting adverse incidents.
Date f Issue: March 2016 Page 11 f 12 6.4 Infrmatin sharing Identify the prcess in place t ensure patients r service users, their families and ther health care prfessinal are infrmed abut the scpe and limits f the Nurse Prescribing Inising Radiatin (X-Ray) initiative. 6.5 Recrd Keeping Detail the requirements fr dcumentatin and maintenance f recrds including the need fr accurate, legible, unambiguus and cntempraneus recrds. 6.6 Mnitr f Prescribing Outline the prcess t mnitr the safety, effectiveness, apprpriateness and acceptability f prescribing inising radiatin (X-Ray) practice. Detail the requirement fr and arrangements in place t enable a Nurse Prescribing Inising Radiatin (X-Ray) t mnitr their wn prescribing practice. Outline the requirement fr the nurses prescribing Inising Radiatin (X-Ray) t cllect and input all infrmatin required fr the Natinal Nurse Prescribing Inising Radiatin (X-Ray) Minimum Dataset. 6.7 Audit Detail the auditing prcess t be put in place by the health service prvider [name rganisatin] including arrangements necessary t ensure that practice is based n sund clinical evidence, and is cst effective. 6.7 Changes t the status f Nurse Prescribing Inising Radiatin (X-Ray) Detail the prcess t be fllwed, if there is a change in: Cntact details, such as name, address etc. Scpe f practice. Cmpetencies (if a Nurse prescribing Inising Radiatin (X-Ray) is ut f practice fr a perid f time; fr example, lng-term sick leave, detail the prcess t be fllwed t ensure they are still cmpetent t prescribe); and In additin, the Nurse Prescribing Inising Radiatin (X-Ray) is respnsible fr maintaining cmpetence fr their prescriptive authrity as per Requirements and Standards fr Nurse Educatin Prgrammes fr Authrity t Prescribe Inising Radiatin (X-Ray) (An Brd Altranais 2008). (Insert text here) What is the anticipated utcme that is intended r that guides yur present actins?
Date f Issue: March 2016 Page 12 f 12 6.7 References An Brd Altranais (2000) Scpe f Nursing and Midwifery Practice Framewrk. An Brd Altranais, Dublin. An Brd Altranais (2008) Requirement and Standards fr Nurse Educatin Prgrammes fr Authrity t Prescribe Inising Radiatin (X-Ray). An Brd Altranais, Dublin. Health Prtectin Agency (2009) retrieved frm http://www.hpa.rg.uk/webw/hpaweb&page&hpawebautlistname/page/1153846673585?p=1153846673585 n April 8, 2009 Abve link t be cnfirmed??? Belw is a suggestin link Health Prtectin Agency Annual reprt and Agency 2009 https://www.gv.uk/gvernment/uplads/system/uplads/attachment_data/file/248278/0612.pdf Bibligraphy Appendices Disclaimer @2016 Our Lady s Children s Hspital Crumlin, Dublin 12. All rights reserved. N part f this publicatin may be reprduced, stred in a retrieval system r transmitted in any frm r by any means withut the prir written permissin f the cpyright hlder. Every effrt has been made t ensure that the infrmatin prvided is accurate and in accrd with standards accepted at the time f printing.