Practice Standards FAQ

Frequently Asked Questions

The following is provided for information purposes only and should not be considered legal advice. Nothing provided herein should be accepted as a substitute for legal advice provided by a licensed attorney in your state.

The following issues are among the most common received by the ASRT Office of Practice Standards:

Medication Administration

 

Verbal Orders

 
 

Medication Administration

 

Is it within the scope of practice for an R.T. to:

  • administer contrast by any means?
  • administer medications other than contrast?
  • perform venipuncture?
  • start or maintain intravenous access?

Answer: The ASRT Practice Standards for Medical Imaging and Radiation Therapy support that medication administration, including administration of contrast media, are within radiologic technologists' scope of practice with appropriate clinical and didactic education where federal or state statues and/or institutional policy permit. The ASRT House of Delegates has adopted the following position statement on the subject:

Medication and Contrast Media Injections by Radiologic Technologists
It is the position of the American Society of Radiologic Technologists (ASRT) that, absent specific protocols, the parenteral injection of contrast media and other medications by radiologic technologists be performed only when a licensed independent practitioner or radiologist where required, is immediately available to ensure proper diagnosing of and treatment for possible allergic reaction.

Adopted, Resolution 06-3.12, 2006
Amended, Main Motion, C-09.52, 2009

Throughout the Practice Standards, there are several references to radiologic technologists starting and maintaining IV access per orders when applicable. Additionally, most of the standards indicate that performing venipuncture and administering medication are within the scope of practice. All of these statements indicate that the radiologic technology profession considers contrast administration and medication administration to be within the scope of practice. However, it is dependent upon these practices being permitted by state statute, regulation, or institutional policy. Additionally, The Joint Commission requires that every facility have policies in place specifying who can administer medications, via which medium and under what supervisory levels. If the radiologic technologist performs an injection without a policy permitting the practice, The Joint Commission could cite the facility with a requirement for improvement. Therefore, it is imperative that you review the policies and procedures of your institution if it is required to be Joint Commission accredited.

 

If I am injecting contrast, does a physician have to be present:

  • in the room?
  • on the premises?

Answer: The answer depends on a number of factors. Some states have addressed this issue in terms of physician delegation. The state may require a physician be present in the room personally observing the injection; other states require there be a physician on site. Moreover, other states require that a physician must arrive within a certain amount of time following the completion of the injection. Unfortunately, some states do not address the issue at all in any statute or regulation. If your facility is Joint Commission accredited, this matter is addressed in the same standard that requires a policy be in place addressing who may complete injections. Supervisory requirements also are mandated as part of the policy. Therefore, it falls to institutional policy.

For those facilities in states that are silent on the issue and do not require Joint Commission review, it can be a difficult issue especially if a facility's physician insists on the practice. The physician who heads such a facility should be encouraged to consult with an attorney to determine the best course of action for the facility.

Again, the ASRT House has adopted the following position statement on the subject:

Medication and Contrast Media Injections by Radiologic Technologists
It is the position of the American Society of Radiologic Technologists (ASRT) that, absent specific protocols, the parenteral injection of contrast media and other medications by radiologic technologists be performed only when a licensed independent practitioner or radiologist where required, is immediately available to ensure proper diagnosing of and treatment for possible allergic reaction.

Adopted, Resolution 06-3.12, 2006
Amended, Main Motion, C-09.52, 2009

However, when in doubt, R.T.s should consult the American Registry of Radiologic Technologists Standards of Ethics if there are questions about the absence of statutes and regulations. Much is left to individual discretion, but R.T.s should consider the following items.

From the ARRT Code of Ethics:

  1. The radiologic technologist conducts herself or himself in a professional manner, responds to patient needs, and supports colleagues and associates in providing quality patient care.
  2. The radiologic technologist assesses situations; exercises care, discretion, and judgment; assumes responsibility for professional decisions; and acts in the best interest of the patient.

From the ARRT Rules of Ethics:

Registered Technologists, Registered Radiologist Assistants, and Candidates engaging in any of the following conduct or activities, or who permit the occurrence of the following conduct or activities with respect to them, have violated the Rules of Ethics and are subject to sanctions as described hereunder:

* * *

  1. Failure or inability to perform radiologic technology with reasonable skill and safety.
  2. Engaging in unprofessional conduct, including, but not limited to:
    1. a departure from or failure to conform to applicable federal, state or local governmental rules regarding radiologic technology practice; or, if no such rule exists, to the minimal standards of acceptable and prevailing radiologic technology practice;
    2. any radiologic technology practice that may create unnecessary danger to a patient's life, health or safety; or
    3. any practice that is contrary to the ethical conduct appropriate to the profession that results in the termination from employment. Actual injury to a patient or the public need not be established under this clause.
  3. Delegating or accepting the delegation of a radiologic technology function or any other prescribed health care function when the delegation or acceptance could reasonably be expected to create an unnecessary danger to a patient's life, health or safety. Actual injury to a patient need not be established under this clause.

* * *

  1. Engaging in any unethical conduct, including, but not limited to, conduct likely to deceive, defraud or harm the public; or demonstrating a willful or careless disregard for the health, welfare or safety of a patient. Actual injury need not be established under this clause.

These ethical requirements need to be considered as well. Additionally, the ethical requirements may serve as a means to compel the facility managers to develop a procedure given that the technologist could be in violation of ethics requirements.

 

Verbal Orders

 

Can an R.T.:

  • receive verbal orders?
  • receive telephonic orders?
  • record the orders in the patient's chart or electronic medical record?

Answer: The first step is to review ASRT's position statement on the subject:

Verbal and/or Telephone Orders
It is the position of the American Society of Radiologic Technologists (ASRT) that it is within the scope of practice of radiologic technologists to receive, relay and document verbal, facsimile, electronic and/or telephone orders in the patient's chart where federal or state law and/or institutional policy permit.

Adopted, Resolution 05-3.02, 2005
Amended, Resolution, C-07.36, 2007
Amended, Main Motion, C-09.26, 2009

The statement serves to indicate that receiving the order and recording the appropriate notation in the patient chart or electronic medical record is within scope of practice. Individual institutions may have specific guidelines concerning verbal order processing, including how soon after issuing the order should the ordering physician sign the order. The Centers for Medicare and Medicaid Services and The Joint Commission have each issued requirements pertaining to verbal orders and the means of processing the orders.

Nurses might insist that writing in a patient's chart or medical record is limited to nursing staff and physicians. Please be aware that unless there is a written institutional policy, state administrative regulation or state statute limiting who may actually record information in the chart or electronic medical record, it is generally permissible for R.T.s to complete this task.

Stay tuned for updates to this section.

Questions or Comments?

For practice issues, contact Becky Apodaca phone at 800-444-2778 or via e-mail at AskTheCouncil@asrt.org

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