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Written in accordance with, the Northumbria Healthcare NHS Foundation Trust policy - 'Referrals for Radiological Investigations: Policy for non-medical, registered professionals'

Contents

• Section 1. Working environment / context
• Section 2. Training & Clinical supervision
• Section 3. Range of investigations / scope of practice.
• Section 4. Operational notes.

Section 1 - Work environment i.e. the context of practice

Non-medical requestors will be expected to apply advanced clinical skills in order to:

• Provide effective high quality care to the acutely and chronically ill patient.
• Assess patients.
• Initiate early interventions and investigations.
• Request and review specifically identified radiological investigations (as agreed with clinical supervisors.)

Early referral for radiological investigations by the nurse practitioner will mean:

• Reduced delays in appropriate treatment.
• Reduced patient waiting and potential discomfort.
• More efficient use of medical time and resources.

It is the responsibility of the requestor to ensure the report for each request that they make is read and that appropriate action is taken. Significant findings, or findings of uncertain significance or meaning, must be reported to the Consultant or Senior Clinician responsible for that patient. Significant findings would be reports including, but not limited to, significant unexpected pathology, a new diagnosis of suspected malignancy or new trauma.

Section 2 - Training & Clinical supervision

Training is as laid out in Northumbria policy document CG52 “Referrals for Radiological Investigations: Policy for non-medical, registered professionals”

IRMER training is theory based, via Kallidus at https://northumbrianhs.kallidus-suite.com The list of required modules to be completed can be seen as appendices to document CG52.

The non-medical requestor must demonstrate the following to the clinical supervisor:

1. Adequate theoretical and practical clinical training under the supervision of a Clinical Supervisor
2. Knowledge of referral and clinical guidelines for a given scope of practice and local referral pathways.
3. A clear understanding of their responsibilities and accountabilities within their professional organisation.
4. Appropriate knowledge and understanding of the purpose of each investigation.
5. A clear understanding of the value of particular radiological examinations in specified clinical contexts.
6. The correct procedure for requesting each examination.
7. That they can provide accurate and appropriate clinical information for each request.
8. Appropriate knowledge of when and how to contact radiology staff.
9. Appropriate knowledge of when & how to contact medical staff with regard to potentially significant findings.
10. Has completed the on-line IR(ME)R training.
11. The NMR will commit to completing an audit in 6 month's time of 10 exams as per below.

The clinical supervisor will complete and sign the 'Record of assessment of competency' (appendix A) to confirm that the non-medical requestor has satisfied the above criterion. This document will also identify a specific range of radiological investigations which it is appropriate for the non-medical requestor to request.

Review of investigations made

After the first six months of referrals the clinical supervisor and the non-medical requestor will:

• Review a sample of the referrals made (10 of each type e.g. x-ray, CT, Ultrasound) together with the reports.
• Discuss the appropriateness of the sample referrals.
• Discuss the quality of the sample referrals (the clinical information provided).
• Discuss any actions taken as a result of the referral, including actions taken on any significant findings.
• Discuss any concerns, identify any further training needs and plan to meet them.

It will be the responsibility of the non-medical requestor to arrange their review and to retain evidence of this.

Nurse practitioners or equivalent may be instructed to stop referring for radiological opinion if this is considered appropriate by the supervisor.

Refresher training.

IR(ME)R training must be refreshed every 3 Years as described in CG52.

Section 3 - Range of investigations / scope of practice

The following referrals are appropriate from non-medical staff working under this plan.

Section 4 - Operational notes

• A copy of this plan must be retained by the lead specialist nurse or equivalent for this area. (A PDF copy will be sent on completion)
• A copy of this plan will be sent to the IRMER administrators. irmer@northumbria-healthcare.nhs.uk
• Each non-medical requestor must complete a registration fomr on this site. The clinical supervisor must review and approve.
• The non-medical requestor must retain this with evidence of on-line IRMER training.
• The local plan will be reviewed every 3 Years
• Please address any queries about this plan to the lead clinician and lead specialist nurse for this area.