Medical Directive, Diagnostic Imaging Nurse Led Outreach Team
RN’s and RN-EC’s
Manual:
Policy No:
Section:
Date Effective:
Developed by:
Date Revised:
Approved by:
Date Reviewed:
Key Words:
Cross Reference to:
A printed copy of this document may not reflect the current, electronic version on York Central Hospital’s
Intranet.’ Any copies of this document appearing in paper form should ALWAYS be checked against the
electronic version prior to use.
Order and/or Delegated Procedure:
Appendix Attached: x Yes
No
Title:
Ordering of diagnostic imaging studies by the RN’s or RN-EC’s working in the Nurse
Led Outreach Team (NLOT), based upon a plan of care developed in collaboration with
the attending physician. The list of approved diagnostic imaging studies can be found
in Appendix A.
Recipient Patients:
Appendix Attached:
Yes
No
Title:
Residents of nursing homes who have entered into Memorandums of agreement with
the York Central Hospital Nurse Led Outreach program.
Authorized Implementers:
Appendix Attached:
Yes
No
Title:
RN’s and RN-EC’s in the Nurse Led Outreach Team, employed by York Central
Hospital who possess the knowledge, skill, judgment and demonstrated competency to
implement this medical directive as outlined in the Performance Readiness Plan.
Indications:
Appendix Attached: x
Yes
No
Title:
A printed copy of this document may not reflect the current, electronic version on York Central Hospital’s Intranet. This material
has been prepared solely for the use at York Central Hospital. York Central Hospital accepts no responsibility for use of this
material by any person or organization not associated with York Central Hospital. No part of this document may be reproduced
in any form for publication without the permission of York Central Hospital.
When the history and physical examination of a resident suggest the need for further
assessment with diagnostic imaging technologies. This medical directive gives
authority to the RN’s and RN-EC’s in the Nurse Led Outreach Team to write orders for
diagnostic imaging studies not currently on the College of Nurses of Ontario Approved
List of Diagnostic Tests for RN-EC’s. The list of approved studies can be found in
Appendix A.
Contraindications:


Tests not on the approved list cannot be ordered
Patients with know iodine allergies cannot under studies involving dye.
Consent:
Appendix Attached:
Yes
No
Title:
The resident or SDA must consent to services of the Nurse Led Outreach Team. If the
resident or SDM does not wish to have the NLOT participate in his/her care, the most
responsible physician (MRP) will complete the assessment and write all orders.
Guidelines for Implementing the
Appendix Attached:
Yes
No
Title:
Order / Procedure:
The NLOT RN, or RN-EC is expected to complete the following prior to writing orders
for diagnostic imaging studies.
1). A thorough assessment of the resident's current complaint/reason for referral, past
medical history, past surgical history, laboratory and diagnostic test results, and
focused physical examination as appropriate. If finding and best practices indicate that
diagnostic imaging an order for the appropriate test is to be written on the individual
institution’s. The patient assessment and plan of care are to be documented as per the
individual institution’s policy and the College of Nurses documentation standards.
Where hand written, all documentation is expected to be legible.
2). Communicate plan of care in a manner agreed upon by the attending physician and
that is aligned with the principles of collaborative practice.
3). Discuss plan of care with resident or SDM and obtain consent. Discussion is to
include the rational for ordering the test, risks and benefits of the procedure, and
possible plans of care if abnormal results are found.
A printed copy of this document may not reflect the current, electronic version on York Central Hospital’s Intranet. This material
has been prepared solely for the use at York Central Hospital. York Central Hospital accepts no responsibility for use of this
material by any person or organization not associated with York Central Hospital. No part of this document may be reproduced
in any form for publication without the permission of York Central Hospital.
Documentation and Communication: Appendix Attached:
Yes
No
Title:
Orders are to be written, in legible hand writing, on the doctors' order sheet. Orders are
to include date, the the test, and any special preparation required for the test.
Whenever possible words are to be written out in long-hand to avoid confusion. The
RN or RN-EC is to sign each order with her name, and credentials. The NP is available
by phone, and is to ensure each nursing home has current contact information.
Review and Quality Monitoring
Appendix Attached:
Yes
No
Title:
Guidelines:
The NLOT RN’s and RN-EC’s will participate in the annual performance review
process. In addition the person in this role is expected to remain current in the area of
long-term care, primary geriatric care and appropriate use of diagnostic imaging
studies. In addition, as a registered nurse with the College of Nurses of Ontario,
participation in reflective practice is expected. This includes "Reflective Practice" and
"practice review".
Administrative Approvals (as
applicable):
Appendix Attached:
Yes
No
Title:
Approving
Physician(s)/Authorizer(s):
Appendix Attached:
Yes
No
Title:
Appendix Attached:
Yes
No
Title:
References:
1.
2.
3.
4.
CNO. Practice Standard: Registered Nurses in the Extended Class, 2007.
CPSO. Delegation of Controlled Acts, Policy #4.03, 1999, Updated, Feb 2007.
RHPA, section 29(1)(a)
An Inter-Professional Guide on the Use of Orders, directives and Delegation for
Regulated Health Professionals In Ontario. The Federation of Health Regulatory
College of Ontario’s (FHRCO), 2007.
A printed copy of this document may not reflect the current, electronic version on York Central Hospital’s Intranet. This material
has been prepared solely for the use at York Central Hospital. York Central Hospital accepts no responsibility for use of this
material by any person or organization not associated with York Central Hospital. No part of this document may be reproduced
in any form for publication without the permission of York Central Hospital.
APPENDIX A
Approved Diagnostic Imaging Studies For For NLOT RN’s and RN-EC’s
X-ray
Upper Extremities
Lower Extremities
Abdomen (KUB/Flat Plate)
Chest/Rib films
Sinus Films
Spine (cervical, thoracic, lumbar).
Hips
Pelvis
Upper G.I. (With small bowel follow through)
Barium Enema
Mammography
Ultra-Sound
Abdomen (including bladder scans)
Pelvis
Breast
Doppler studies – Lower Limb, Upper Limb,
venous or arterial.
Other Studies
EKG’s
Holter Monitor
A printed copy of this document may not reflect the current, electronic version on York Central Hospital’s Intranet. This material
has been prepared solely for the use at York Central Hospital. York Central Hospital accepts no responsibility for use of this
material by any person or organization not associated with York Central Hospital. No part of this document may be reproduced
in any form for publication without the permission of York Central Hospital.