The EPA, the Ministry of Health and the then Australian Institute of Radiography developed a user licence for remote operators (IA14R) to allow limited radiography services to be provided in rural and remote areas of New South Wales.
What has changed and why?
The remote operator user licence conditions (IA14R) have been amended to make the intent clearer and address changes in work practices in remote locations. Definitions of key words have also been included.
The licence conditions are intended to simplify the accountability of referrers of x-ray examinations regarding the use of remote operators in place of radiographers and to ensure that the conditions of use are consistent across Local Health Districts. It is the responsibility of the employer to ensure that employees carry out these procedures.
Radiographer 'not available to attend'
To clarify the existing condition that the x-ray examination may only be performed by a remote operator when a radiographer is not in attendance, a definition has been added to specify what 'not available to attend' means for radiographers. A radiographer is taken to be unable to attend if:
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the radiographer has declared that they are unavailable
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the radiographer is not in attendance at the facility or due at the facility in the next six hours
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there is no radiographer rostered or on call
- the radiographer is unable to attend in a timely manner due to restrictions in distance/time where the well-being of the patient will be affected if the x-ray examination is not undertaken.
Certifying the need for x-rays when a radiographer is unavailable
Changes have been made to the remote operator user licence conditions (IA14R) to make the licensee (remote operator) accountable for documenting that the compliance process has occurred for standard remote operator examinations outlined under Section 6 of the licence.
The change now means the remote operator must document that the licence conditions (1,2,3 and 4) have been adhered to prior to conducting an x-ray of the chest, fingers, hand, wrist, forearm, elbow and shoulder girdle, toes, foot ankle, lower leg, knee upper leg and pelvis.
For example, the remote operator must
- inform the referrer that the radiographer is unavailable
- confirm with the referrer the examination can't wait until a radiographer is available
- certify (document) on the patients' medical record the above action has occurred.
An example of the documentation may be where the remote operator writes a note and initials it on the request form or the medical record e.g. referrer informed radiographer is unavailable and remote operator is taking the examination.
Condition 7 of the IA14R user licence allows the use of any radiation apparatus, at any time for any radiological examination, not being limited to those set out above, if requested to do so by a referrer who
- reasonably considers that the life or well-being of the patient could be seriously threatened if the examination is not undertaken immediately, and
- certifies this on the patient's medical record. This certification must be sighted and countersigned by the licensee on the medical record before the commencement of any e-ray examination. This is also to be done if the licensee is a registered medical practitioner who is also the referrer.
In this case, an example of certification may be where the referrer writes on the request form 'urgent examination - may be performed by remote operator', this could then be confirmed by the remote operator, who has made sure a radiographer is not available and countersigned manually or digitally documented depending on the systems used.