201-1216 / Nurse Prescribing of Ionising Radiation

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
Office of Nursing and Midwifery Services, Health Service Executive


Quality improvement project

GOP Description
Implementation level
Clinical settings
Nurse Prescribing of Ionising Radiation has been implemented in various clinical settings in 35 acute care services.
The aim of the initiative is to enhance the health system’s capacity to respond to service need by maximising nurse prescribing of ionising radiation (X-Ray). Developing nurses that are capable and confident in their authority to prescribe ionising radiation (X-Ray) will aid the delivery of competent and responsive services.
All registered nurses, who fulfil specific criteria; with one year in the area in which the prescribing of ionising radiation is proposed; Certificate in Nurse Authority to Prescribe Ionising Radiation (X-Ray) QQI Level 8 Special Purpose Award, Evidence of CPD, support from employer and a nominated medical practitioner mentor.
In June 2007 the Minister for Health and Children introduced legislation which amended the definition of ‘prescribers’ of medical ionising radiation to include registered nurses maintained on the register of nurses by An Bord Altranais. In February 2008, An Bord Altranais published the Requirements and Standards for Nurse Education Programmes for Authority to Prescribe Ionising Radiation (X-Ray). Following this, the ONMSD established, in September 2008, a national Advisory Committee for the Implementation of Nurse Prescribing Ionising Radiation (X-Ray). Its role was to advise the HSE on the most appropriate way to introduce nurse prescribing of medical ionising radiation (X-Ray). This involved the establishment of robust systems of clinical governance and a collaborative approach to implementation at local and national level. The Guiding Framework for the Implementation of Nurse Prescribing of Medical Ionising Radiation (X-Ray) is an outcome of the work of the National Advisory Committee. Parallel work which supported the introduction of nurse prescribing of medical ionising radiation (X-Ray) includes the work of the Education Sub-Committee who developed the nurse education programme in consultation with the Faculty of Radiologists, Royal College of Surgeons in Ireland and the Centres of Nurse Education. The first programme commenced in May 2009.
Timeframe implementation
Since 2009, this initiative has been implemented in 35 Acute Care Service providers. There are 200 nurses who have prescribed at least 113, 500 X-Rays. The initiative is evolving and adapting in response to health service reconfiguration and restructuring currently underway in Ireland. Building capacity is an ongoing objective.
Implementation tools available
• The Requirements and Standards for Nurse Education Programmes for Authority to Prescribe Ionising Radiation (X-Ray)
• A Guiding Framework for the Implementation of Nurse Prescribing of Medical Ionising Radiation (X-Ray) in Ireland
• Education Guidelines
• Declaration Form, identifying required governance arrangements.
• National Policy for Nurse Prescribing of Medical Ionising Radiation (X-Ray)
• A Database of Nurses with Authority to Prescribe Ionising Radiation (X-Ray) for the purpose of monitoring was established.
• Indemnity statements from the State Claims Agency outlining indemnification for all public sector stakeholders involved in the prescribing initiative.
Implementation cost
• Currently the salaries of a Director of Nursing.
• A total of 200 nurses have been funded by the Health Service Executive to undertake the education programme. Cost of the programmes to date is € 111,500 this equates to €500 per participant.
Method used to measure the results
An independent external evaluation was undertaken in 2014.
The aims of the evaluation;
1. Evaluation of the education programme
2. Evaluation of the implementation of HSE Guiding Framework by Healthcare Providers
3. Present findings and suggest recommendations through the Project Steering Group for consideration by the National Advisory Committee
• Good levels of support with the majority of stakeholders reporting a positive impact on patient care and meeting the clinical the needs of patients.
• Nurses were effectively and competently prepared to practice. The radiological investigations requested were appropriate based on the patient’s history and/or physical examination.
• Patients were highly satisfied with the care they received which was comprehensive including education and advice and reduced the time they spent waiting for treatment.
• Positive impact on the professional role of nurse.
• Facilitating patient access to treatment and care in an equitable and timely manner.
Analysis of the results
The Independent External Evaluation identified 11 recommendations which are currently being implemented under Governance, Prescribing Practice, Educational Preparation for Prescribing Practice, Continuing Professional Development and Public Patient Involvement.
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
1.The public service moratorium on staff recruitment in place since 2008 resulting in no or limited recruitment, no replacement of retired/resigned staff. Staff training was predominantly limited to mandatory training.
2.Requirements for inputting prescription data onto the Database of Nurses with Authority to Prescribe Ionising Radiation (X-Ray).
Describe the strategies used to overcome the barriers (If needed)
1) A recent relaxation of the moratorium on staff recruitment and improved staff release for education and training.
2) Barriers being addressed through the implementation of the recommendations from the Evaluation.
Other information
Other information about the GOP that you would like to add (Link or attached document)
There is no specified text here