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Professional Guidance

An individual’s scope of practice is completely unrelated to day of week, time of night or who else is on duty.

There is an over-riding duty to put the care and safety of each patient first and a significant duty to play a full and proper part in the continuity of care of every patient. 

Radiographers have an explicit duty to make judgements in relation to their competence and capability at all times, and to practice in accordance with their personal scope of practice and competence, as well as the codes of conduct and ethics and standards of performance established by their regulatory and professional bodies. Current versions of these codes and standards are always available at www.hcpc-uk.org and www.sor.org. A list of useful resources is given in Appendix A.

It is acceptable for radiographers to decline to do things they believe would be unsafe and/or subject the patient to increased risk. Examples might be:

  • Declining to administer contrast medium to a patient known to have severely compromised renal function in the absence of a relevant medical opinion on the potential effect on the patient; 
  • Indicating that it will not be possible to provide a report (in any form) on unusual/complex imaging appearances which the radiographer considers is beyond his or her level of competence (although if there is any suspicion that potentially critical, urgent or significant findings may be overlooked, then this must be drawn to the immediate attention of the referrer and such action documented).

However, while it is acceptable to decline to undertake specific acts as in the above hypothetical scenarios, it is unacceptable to do nothing at all as this leaves both the referrer and the patient unsupported. Scenarios such as the above require discussion between the radiographer concerned and the referrer or, if the referrer is unavailable, a relevant on-duty health care professional. Often this will be the on-call consultant radiologist or oncologist, or the specialist registrar. 

It is essential to ensure that systems of work are safe and properly resourced. This includes, for example, ensuring that emergency services are readily accessible should a patient collapse in the imaging or radiotherapy department; or that there is access to specialist advice appropriate to the nature of the service being provided. A particularly important element in designing safe shift work systems is to take account of fatigue with its deleterious effects on health and performance, for example, by building in proper rest breaks, and making sure there are regular health assessments.  

Each system of work needs to be subjected to a full risk assessment including, for example, consideration of lone working, use of ionising radiation and health and safety matters; and there should be a periodic review of systems of work with immediate review in the event of an adverse incident.

It is a professional responsibility to present ‘fit’ for duty. In the context of a shift system this means being fit to be on duty regardless of the time of that duty. It also means understanding that long and night shifts are inherently more fatiguing than short/moderate and day shifts, and taking reasonable steps to mitigate the effects of fatigue. The employer also has an obligation to take steps to minimise fatigue in staff. This includes ensuring shift patterns are reviewed regularly and the effects of fatigue on an individual are monitored.

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