aguthrn

Medication administration is not within the scope of practice of an RT, with the exception of Contrast media. Most facilities have a competency that documents safe administration of contrast after validation of knowledge base. Then they can only inject contrast when a Radiologist is immediately available. Our hospital has an Outpatient facility that is associated with us, but they are only authorized to administer contrast when a Radiologist is immediately available on site. This does not include "tele-Rad" coverage. Nuclear Medicine is an exception to this rule as they commonly drawl blood and inject isotopes. Although their scope is slightly different than the routine radiology technologists, it is not within their scope of practice to administer any other medications, oral or IV. I hope you find the answers, I have been the NM of large hospital Radiology department for approx three years now and I still learn something new every day. Good Luck!

What they are saying right now is that the radiologist who doesn't even lay eyes on the the patient for CT with contrast must review all medications taken by the patient and advise which ones are to be resumed post imaging. Patients are frequently gone prior the exam being looked at by the Radiologist (unless it is a protocol for stat read). I have spoken with the Manager of our pre and post surgical unit and they are battling this as well, because physicians don't want to take responsibility for medication they are not prescribing, especially surgeons/radiologist that are not managing the daily care of these patients. They traditionally advise the nurses to contact the physician that ordered the medication. Since patients routinely are on multiple medications sometimes ordered by various different doctors, this is problematic and time consuming. For nurses who are already being pressed to get those out-patient's in and out, not only for patient satisfaction, but for optimal bed utililization this can and will be over whelming. Very frustrating for us all.

I believe that everyone is talking about the new JCAHO standard on Medication reconciliation. This standard is new for 2006 and includes all encounters in the hospital setting. It is my understanding that this JCAHO standard indicates that all patients that enter the hospital, regardless of in-pt or out-pt status, must have a reconcilation of their medications upon arrival and again prior to discharge. The standard indicates that this is necessary in the out-patient setting as well if the patient has any medication administration during this visit (including, but not limited to contrast). So I think simple imaging studies not requiring contrast or other medication administration would be the only ones exempt from this process. This new standard presents a major RN staffing issue within the Radiology Department. As we are all aware that in larger facilities with current staffing ratios, it would be impossible to meet this standard. Another major concern with this that I have is that the standard reads that this reconcilation can be done by a Nurse, Physician or Pharmacist. It also states that the medications must be reconciled to include the following information: Medication, Dose, Frequence and Next dose due. The Radiologist, who does not have a general medical knowledge of these patients are not going to be willing to assume the responsibility of reconciling medications for all of these patients. When I spoke with the Director of pharmacy, I was advised that it was not very practical to have the in-patient pharmacist do the reconcilation as it would be very timely and potentially delay the procedure for more than an hour. As for the RN's, they can reconcile what the patient/family member states they are taking upon arrival, but then would need to advised them which of those medications to resume upon discharge. This would in effect be ordering medications which is outside our scope of practice. If anyone has a head start, please let me know, as I would welcome any advise. I work at a hospital with a very busy Radiology Department and can not imagine the total impact that this is going to have.