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17. Professional responsibilities of the radiographer

17.1  MRI safety screening questionnaires

17.1.1

Risk/benefit decisions must be taken by the MRI team in consultation with the patient or their guardian.  Before the patient is allowed to enter the controlled area, the authorised person (usually the MR operator/radiographer) is responsible for ensuring that the risks are made clear and that the evidence provided is based on the most current and up to date literature.

17.1.2

Written documentation, normally in the form of a questionnaire, regarding the risk assessment for each patient should be completed by the patient and checked through with them by the authorised person.  Any discrepancies or queries should be discussed with the patient and the decision to scan should be made in conjunction with the local rules and employing authority policies.

17.1.3

The questionnaire should be signed and dated by the patient and countersigned as checked by the MR operator.

17.1.4

There may be occasions when it is not possible for the patient to be able to answer the safety questionnaire directly, for instance, in the case of the unconscious patient, or clients who do not speak English.

17.1.5

In the case of the unconscious patient, close reference should be made to the patient notes and, ideally, the next of kin may be asked to complete the questionnaire. Reference should be made to employing authority policy on consent and this should be reflected in the local rules.  Please also refer to 17.2.1.  Any doubt about patient status with regard to MRI safety should be rigorously pursued; this may involve, for example, plain radiography to establish metallic intra-orbital foreign body (IOFB).

17.1.6

Patients who do not speak English as their first language should be accorded the same information and confidentiality as any other patient.  Ideally, an employing authority translation service, using an approved translator, should be utilised.  This should ensure that the questions put to the patient, and the answers received, are accurate and not changed.  A translator may be booked in advance, or a phone translation service, approved by the employing authority should be utilised.  If the translator is present they should sign the form to confirm that they asked the patient all the questions listed and that the answers noted are a true record of those received.  If the translator is not present, a note of their name or identification code should be made on the form.  The safety of the patient, however, is the responsibility of the authorised person, usually the scanning radiographer.  It should not be common practice to use a relative for translation purposes and it is inappropriate for minors to perform this function.

17.2.1   Duties

Under your duties as a registrant with the HCPC, you must obtain informed consent to provide care or service.   This involves explaining the service you are planning to provide any risks involved and any other possible options. 23

Radiographers undertaking a clinical imaging diagnostic exam have a duty of care to ensure that patients are fully aware of the procedure and have consented to it.  The health professional carrying out the procedure is ultimately responsible for ensuring that the patient is genuinely consenting to what is being done: it is they who will be held responsible in law if this is challenged later. 24

17.2.2   Consent and adults with impaired capacity

The HCPC acknowledges that in some situations such as emergencies or where a person lacks a decision making capacity, it may not be possible for you to explain what you propose, get consent or pass on information.23  The SCoR 24 advises that all reasonable steps must be taken to support a patient to make a decision.  This involves taking extra time with the patient and using language appropriate to the level of understanding.

The patient’s carers may be able to help in this regard but they cannot give valid consent on behalf of the patient, including the patient who lacks capacity.  Acting in the best interests of the patient may involve the radiographer delaying or postponing the procedure if, in their opinion, more time needs to be taken to obtain consent.  The referrer should be informed and discussions may include possible alternative procedures, if relevant.

If the employing authority has policies regarding consent which have been developed locally these policies should be followed.  If, after taking every practical step to achieve consent from the patient, consent is not achievable, the radiographer needs to be clear that by providing imaging and/or treatment they are acting in the best interests of the patient.

Radiographers must record decisions taken along with a brief explanation of why the decisions were taken.

17.2.3   Consent and the child

Consent for MRI scanning in the case of minors should reflect employing authority policy.

17.2.4

For further information and advice on Consent, please view the following SCoR publications:

Consent to Imaging and Radiotherapy Treatment Examinations 24

Patient Identification, Confidentiality and Consent: Further Guidance25

https://www.sor.org/learning/document-library/patient-identification-confidentiality-and-consent-further-guidance    (accessed February 28th 2013)

17.3  Reporting of incidents and near misses

All incidents and near misses related to patient or staff safety within the MRI unit should be reported in accordance with your local employers’ rules.  Also, incidents and near misses involving MR diagnostic equipment should be reported to the MHRA.  Incident forms are available on their website and you can report an incident online:

http://www.mhra.gov.uk/Safetyinformation/Reportingsafetyproblems/Devices/Medicaldeviceadverseincidentreportingforms/index.htm   (accessed February 28th 2013)

There are also links for the reporting of incidents in Scotland, Wales and Northern Ireland.

If you are unsure please contact the Adverse Incident Centre: aic@mhra.gsi.gov.uk

17.4  Knowledge, skills and competency

The science of MR and technological developments in equipment and device implant evolves rapidly and radiographers must ensure that their knowledge skills and competencies keep pace with these advances in order to ensure a quality and safe service.

It is a requirement as a registered professional to ensure that you keep your knowledge and skills up to date and that you act within the limits of your knowledge skills and experience. 23

17.4.1   Scope of Practice

In identifying and communicating their individual scope of practice, radiographers must consider the roles and the environments in which they work and ensure that they are educated and competent to operate in their specific roles.25  Further information is available in the SCoR publication ‘The Scope of Practice’.26

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