This ongoing project was set up to consider extension to supply, administration and prescribing responsibilities for AHPs and to date the following has been achieved:
Independent prescribing by therapeutic radiographers
These are in addition to the previous existing AHP medicines mechanisms;
For the latest update on ongoing research into the effectiveness of therapeutic radiographer independent prescribing, please see the information here, including a newsletter of latest activity.
Medicines include contrast agents as well as medicines that might be given before, during or after a diagnostic imaging procedure or during the treatment period for radiotherapy patients.
The law currently states that radiographers are allowed to supply and/or administer medicines using patient specific directions (PSDs) or patient group directions (PGDs). Both diagnostic and therapeutic radiographers can train to become supplementary prescribers and therapeutic radiographers can train to become independent prescribers.
A Patient Specific Direction (PSD) is the traditional written instruction, signed by a doctor, dentist, or non-medical prescriber for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis.
Patient group directions (PGDs) are written instructions to help supply or administer medicines to patients, usually in planned circumstances. They take a significant amount of time and resource to develop and implement.
You can only supply and or administer medicines under PGDs if there is an advantage for the patient without compromising their safety.
PGDs should be put together by a multi-disciplinary group including a doctor, a pharmacist and a representative of any professional group expected to supply the medicines under the PGD. It’s good practice to involve local drug and therapeutics committees, area prescribing committees and similar advisory bodies. Radiographers are listed within the group of health care professionals who are legally entitled to use PGDs .
Guidance on the use of PGDs continues to evolve and develop. Before developing new, or updating old PGDs current information and resources should be reviewed. All information and links can be found on the Specialist Pharmacy Services website .
A statement on the continued use of PGDs for contrast agentsis available (updated in 2018).
Supplementary prescribing is defined as a voluntary prescribing partnership between an independent prescriber and a supplementary prescriber to implement an agreed patient-specific clinical management plan (CMP) with the patient's agreement. Diagnostic and therapeutic radiographers can be supplementary prescribers.
Independent prescribers are responsible and accountable for the assessment of patients with undiagnosed and diagnosed conditions and for decisions about the clinical management required, including prescribing. They assume full accountability for the prescribing decisions they make. They may instruct another person to administer the medicines under the terms of a PSD. An independent prescriber may be a medical prescriber (doctor/dentist only) or a non-medical independent prescriber (nurse, pharmacist, optometrist, physiotherapist, podiatrist or therapeutic radiographer).
Therapeutic radiographer independent prescribers may NOT prescribe controlled drugs. Additional legislation will be changed in 2019 to permit prescribing from a list of controlled drugs.
For a searchable list of HCPC approved supplementary and independent prescribing courses (including conversion courses) please check the HCPC website.
Radiographers who are registered with the Health and Care Professions Council (HCPC) and have undergone and passed a validated course of education and training in either supplementary or independent prescribing are eligible to have their HCPC entry annotated to describe their status as a supplementary and/or independent prescriber. The HCPC sets Standards of Practice for Prescribers.
SCoR provides practice guidance for radiographer prescribers: Practice Guidance for Radiographer Independent and/or Supplementary Prescribers (2016)on the policy and guidance document library
To qualify as a supplementary or independent prescriber, radiographers have to successfully complete a course approved by HCPC, see the standards for education providers seeking HCPC programme approval and also The Outline Curriculum Framework for Education Programmes to Prepare Physiotherapists, Podiatrists and Therapeutic Radiographers as Independent/Supplementary Prescribers and to Prepare Dietitians and Diagnostic Radiographers as Supplementary Prescribers.
This document defines the skills and knowledge for all prescribers including nurses, allied health professionals and doctors. Hazel Boyce is an advanced therapeutic radiographer and supplementary prescriber at Bristol Cancer Institute, working mainly in On Treatment Review. Hazel worked on the recent review and update of the 'Prescribing Competency Framework'.
See document download box below for examples of clinical management plans. which are used in supplementary prescribing
Only certain named registered and regulated health care professionals, such as radiographers, are allowed to use patient group directions. Non-registered practitioners are not allowed BY LAW to use patient group directions and so must not administer prescription only medicines (POM). Generally IV saline IS a POM although prefilled, single use syringes specifically intended for mechanical flushing of ports and catheters are classified as medical devices under the law and, in this case, assistant practitioners and other non-registered health care staff can use them. SCoR obviously expects all members to work competently and lawfully within their scope of practice and hence would not support an illegal practice and so flushing (which is, of course, administration) would not be covered by professional indemnity insurance unless the prefilled syringes (as described above) were in use.
Guidance from the Intensive Care Society on the administration of contrast media using central venous catheters. Endorsed by: Royal College of Radiologists, Society of Radiographers and College of Radiographers.
NHS Evidence (including access to BNF) has a search facility for authoritative, evidence-based information from hundreds of trustworthy and accredited sources.
Electronic Medicines Compendium (eMC) contains up to date, easily accessible information about most of the licensed medicines available for use in the UK. Includes patient information leaflets (PILs) and Summaries of Product Characteristics (SPCs). These include SPCs for contrast media.
Medicines & Healthcare products Regulatory Agency (MHRA) provides SPCs and PILs not on eMC and information about Yellow Card.
If you have any questions feel free to view the Medicines FAQs page to see if it has already been addressed.
Alternatively, Sue Johnson is the professional lead on the safe use of medicines for the Society and College of Radiographers and will be able to answer your questions.