• Physiotherapists prescribe botulinum toxin for dystonia or analgesia for pain during physical treatment.
But there is an obvious gap. Patients attending radiology departments still have to see another health professional if they need medicines, before they can step out of the health facility. However, this could be set to change.
Legislation enabling non-medical prescribing in the UK has allowed radiographers to prescribe as supplementary prescribers since 2005, but not as independent prescribers. Supplementary prescribing involves a written tripartite agreement between a medical prescriber, supplementary prescriber (SP) and patient, known as a clinical management plan, for the SP to prescribe medicines included in the plan for the patient's already diagnosed medical condition. Currently, radiographers are not permitted to progress to independent prescribing, therefore the process by which radiology patients receive medicines is often far from satisfactory. Therapeutic radiographers have been able to use supplementary prescribing with moderate success
because of the repeated nature of the contact with their patients; diagnostic radiographers have had considerable difficulty as they see their patients for single episodes of care. Independent prescribing would enable radiographers in both fields to be more responsive to patient need and streamline care, and to play their part in the achievement of the vision of the NHS Five Year Forward View report1
. This
article aims to demonstrate the need for radiographer independent prescribing for use in both fields of diagnosis and therapy, by considering current and future radiographer practice.
The need for independent prescribing in effective patient management As imaging and therapy examinations have evolved, the need for medicines as procedural adjunct or consequence of process/outcome has increased. Examples of adjunct medicines include contrast media, stimulus triggers such as adenosine, a cardiac stress agent or furosemide, a diuretic. These medicines assist demonstration of pathologies by accentuating physiological and/or anatomical phenomena to make pathologies more easily detected and diagnosed during imaging. Medicines required as a consequence of process include antihistamines such as chlorphenamine for managing reactions to contrast media or medicines for controlling diarrhoea arising from radiotherapy treatment. An example of a type of a medicine indicated as a consequence of outcome is analgesia, for controlling pain if no fracture is identified on a radiograph or for managing cancer-related pain during radiotherapy procedures. In short, medicines are a key component of many diagnostic and therapeutic procedures; they are used to enhance the effectiveness of a procedure or manage procedural side effects, and they help manage the patient after a diagnosis is made, pathology excluded or treatment conducted. In most cases, due to the restrictions on radiographer prescribing, the process by which the patient
receives these medicines is indirect at best and mostly circuitous. Radiologists may prescribe from a clinical history and a procedural protocol and not actually see the patient before prescribing. They may disagree with the radiographer’s choice of analgesia or other medicine to alleviate side effects of a procedure and, quite rightly, as the prescriber is accountable for his or her own prescribing decisions, prescribe something else.
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