A Guiding Framework for theImplementation of Nurse Prescribing ofMedical Ionising Radiation (X-Ray) in Ireland

Office of the Nursing Services Director

Changing practice to support service delivery

ISBN 978-1-906218-26-3 Health Service Executive

May 2009

Office of the Nursing Services DirectorHuman Resources DirectorateHealth Service ExecutiveDr Steevens HospitalDublin 8Ireland

telephone: +353 1 635 2471email: nursing.services@hse.ie

http://www.hse.ie

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ForewordDr. Siobhn OHalloran, Nursing Services DirectorThe Office of the Nursing Services Director,

HR Directorate, Health Service Executive (2009)

Nurse prescribing of medical ionising radiation (X-Ray) supports health services to provide a more

responsive, accessible, effective, timely and efficient service that improves and expedites the patient/

service user journey within the health care service leading to increased levels of patient/service user

satisfaction. In June 2007 Mary Harney TD, Minister for Health and Children introduced legislation

Statutory Instrument No. 303 European Communities (Medical Ionising Radiation Protection) (Amendment)

Regulation 2007. This amended the definition of prescribers of medical ionising radiation to include

registered nurses maintained on the register of nurses by An Bord Altranais. In February 2008, An Bord

Altranais published the Requirements and Standards for Nurse Education Programmes for Authority to

Prescribe Ionising Radiation (X-Ray). Following this, the Office of the Nursing Services Director established,

in September 2008, a national Advisory Committee for the Implementation of Nurse Prescribing Ionising

Radiation (X-Ray). The role of the committee was to advise the Health Service Executive (HSE) on the

most appropriate way to introduce nurse prescribing of medical ionising radiation (X-Ray). This involves

a significant practice change for nursing and other members of the multidisciplinary team. Hence, the

establishment of robust systems of clinical governance and a collaborative, multidisciplinary approach to

implementation of nurse prescribing of medical ionising radiation (X-Ray) at local and national level.

The Guiding Framework for the Implementation of Nurse Prescribing of Medical Ionising Radiation (X-Ray)

is an outcome of the work of the National Advisory Committee. Parallel work which supported the

introduction of nurse prescribing of medical ionising radiation (X-Ray) includes the work of the Education

Sub-Committee who developed the nurse education programme in consultation with the Faculty of

Radiologists of the Royal College of Surgeons in Ireland and the Centres of Nurse Education. The first

programme commenced in May 2009.

It is with great pleasure that I introduce this Guiding Framework for the Implementation of Nurse Prescribing

of Medical Ionising Radiation (X-Ray). The guiding framework aims to support nurses, healthcare managers,

education providers and specifically the newly established Local Implementation Groups to implement

nurse prescribing of medical ionising radiation (X-Ray) in their organisation/service in a multidisciplinary

and collaborative manner. I sincerely hope that it helps health services to deliver the patient and service

outcomes nurse prescribing of medical ionising radiation (X-Ray) aspires to achieve.

I wish to acknowledge the effort and commitment of all those involved in establishing nurse prescribing

of medical ionising radiation (X-Ray). Particular thanks are extended to Mary F. McCarthy, Area Director of

Nursing and Midwifery Planning and Development and her team.

_____________________________

Dr Siobhan OHalloranHealth Service ExecutiveNursing Services Director

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Table of ContentsFOREWORD 1

EXECUTIVE SUMMARY 6

OVERVIEW 9

CHAPTER ONE: Background to Nurse Prescribing of Medical Ionising Radiation (X-Ray) 111.0 Introduction 111.1 Demography 111.2 Health Service Context 111.3 Integrated Health Care 121.4 Enablers of Nurse Prescribing of Medical Ionising Radiation (X-Ray) 121.5 Radiology Governance 13 1.5.1 The International Commission on Radiological Protection 13 1.5.2 Regulatory Bodies Relating to Medical Ionising Radiation in Ireland 15 1.5.3 Professional Bodies Relating to Medical Ionising Radiation in Ireland 171.6 The National Integrated Medical Imaging System 191.7 Legislation Pertaining to Nurse Prescribing of Medical Ionising Radiation (X-Ray). 201.8 Professional Regulation 201.9 Scope of Practice 211.10 Clinical Indemnity Scheme 231.11 Database 231.12 Summary 23

CHAPTER TWO:Project Governance and Development 252.0 Introduction 252.1 Vision 252.2 Core Principles 252.3 Activities for Effective Change 272.4 Advisory Committee for the Implementation of Nurse Prescribing Ionising Radiation (X-Ray) 282.5 National Programme Board 292.6 Local Implementation Group 292.7 Communication Strategies 302.8 Evaluation 322.9 Summary 32

CHAPTER THREE:Education Programme for Nurse Prescribing of Medical Ionising Radiation (X-Ray) 333.0 Introduction 333.1 Education Programme Providers 333.2 Aim of the Programme 333.3 Learning Outcomes 343.4 Programme Accreditation and Award 343.5 Programme Philosophy 343.6 Curriculum Design 353.7 Application Process and Criteria 353.8 Programme Duration 363.9 Learning Resources 363.10 Theoretical Instruction 37

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3.11 Clinical Practicum 373.12 Supporting Clinical Practice 38 3.12.1 Responsibilities of the Clinical Supervisor 38 3.12.2 Support for the Clinical Supervisor 393.13 Assessment of Learning 39 3.13.1 Theoretical Assessment 39 3.13.2 Clinical Practice Assessment 39 3.13.3 External Examiner 393.14 Completion of Programme 403.11 Summary 40

CHAPTER FOUR: Implementation Framework for Introducing Nurse Prescribing of Medical Ionising Radiation (X-Ray) 414.0 Introduction 414.1 Initiating Nurse Prescribing of Medical Ionising Radiation (X-Ray) 42 4.1.1 Step 1: Preparing to Lead the Change 424.2 Planning the Implementation of Nurse Prescribing of Ionising Radiation (X-Ray) 43 4.2.1 Step 2: Building Commitment 43 4.2.2 Step 3: Determining the Detail of the Change 45 4.2.3 Step 4: Developing the Local Implementation Plan 46 4.2.4 Roles and Responsibilities of Other Key Stakeholders 484.3 Implementing Nurse Prescribing of Medical Ionising Radiation (X-Ray) 50 4.3.1 Step 5: Implementing Change 504.4 Mainstreaming Nurse Prescribing of Medical Ionising Radiation (X-Ray) 51 4.4.1 Step 6: Making it the way we do our business 51 4.4.2 Step 7: Evaluating and Learning 524.5 Summary 53

CHAPTER FIVE: Monitoring Nurse Prescribing of Medical Ionising Radiation (X-Ray) 545.0 Introduction 545.1 National Nurse Prescribing Ionising Radiation Minimum Dataset 545.2 Minimum Dataset Definitions 555.3 National Nurse Prescribing Ionising Radiation Data Collection System 555.4 Accessing the System 565.5 Recording Data 565.6 Security 565.7 Organisational Support for the System in Use 565.8 Data Collection System Training 575.9 System Outputs 575.10 Benefits of System 575.11 Summary 57

CHAPTER SIX:Audit of Nurse Prescribing of Medical Ionising Radiation (X-Ray) 586.0 Introduction 586.1 Legislative and Regulatory Framework 586.2 Clinical Audit 586.3 Performance Indicators 596.4 Who Should Undertake Audit and When? 606.5 Data Collection 606.6 Sampling 606.7 Data Analysis 616.8 Making Improvements 616.9 Ethical Considerations 616.10 Summary 61

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REFERENCES 62

GLOSSARY 64

APPENDIX 1: Terms of Reference and Rules of Procedure of the National Radiation Safety Committee 66

APPENDIX 2: Membership of the Advisory Committee for the Implementation of Nurse Prescribing of Ionising Radiation (X-Ray) 70

APPENDIX 3: Policy for Nurse Prescribing of Medical Ionising Radiation (X-Ray) 71

APPENDIX 4: Clinical Indemnity Scheme Statement 83

APPENDIX 5: Membership of Nurse Prescribing of Ionising Radiation Education Sub-Committee 84

APPENDIX 6:Education Programme Application Form 85

APPENDIX 7: Nurse Prescribing of Medical Ionising Radiation (X-Ray) Declaration Form 86

APPENDIX 8: Units of Learning 87

APPENDIX 9: Record of Nurses Supervised Episodes of Prescribing Ionising Radiation (X-Ray) 95

APPENDIX 10: Assessment Tool for Assessing Clinical Competence 98

APPENDIX 11: Guidelines for Reflection on Practice 106

APPENDIX 12: Sample Audit Data Collection Tool for Nurses Prescribing Ionising Radiation (X-Ray) 109

APPENDIX 13: Sample Clinical Audit Report for Nurses Prescribing Ionising Radiation (X-Ray) 111

APPENDIX 14: Sample Quality Improvement Plan for Nurses Prescribing Ionising Radiation (X-Ray) 115

APPENDIX 15: Useful Resources for Audit 116

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LIST OF TABLES & FIGURES:Figure 1.1 Relevant Legislation and Governance Structures for Radiation Protection 13Figure 1.2 Diagram of Profe