Regulation of the sonography profession and patient safety: A comparative study between Australia and New Zealand with implications for statutory regulation.

INTRODUCTION: The primary aim of statutory regulation in healthcare is patient safety. Few studies examine health professionals' perceptions of statutory regulation and its impact on patient safety. Statutory regulation of sonographers is different in Australia and New Zealand which affords a unique opportunity to compare and contrast regulation and its impact. METHODS: An interpretive policy analysis investigated how statutory regulation in the sonography profession addresses patient safety in Australia and New Zealand. A framework analysis explored relevant statutory regulatory policy as well as interviews from sonographers. RESULTS: Four policy documents were included. Thirty-one sonographers in Australia and nine in New Zealand took part in semi-structured interviews. Four themes described statutory regulation and its impact on patient safety: how statutory regulation is implemented in practice to address patient safety; factors contributing to implementation of statutory regulation; impact of statutory regulation on sonographers; and considerations for regulation. CONCLUSION: Statutory regulation provides a reference point for safe practice but can be non-specific in defining sonographers' roles and outlining strategies that address patient safety. Sonographers' perspectives of how regulation of practice addresses patient safety was mixed. A gap exists in sonographers' understanding of the role of statutory regulation in patient safety. IMPLICATIONS FOR PRACTICE: Regulatory authorities must consider how to effectively engage and educate both patients and practitioners about their role in patient safety. Practitioners should also take the opportunity to engage in understanding the role of statutory regulation in enhancing patient safety. A broader view of how Fitness-to-Practice in sonography is managed should be considered in light of the findings.

Australian radiographer roles in the emergency department; evidence of regulatory compliance to improve patient safety - A narrative review.

OBJECTIVES: Using a narrative approach, this paper aims to determine the extent of Australian radiographers' regulatory compliance to improve patient safety when performing appendicular X-ray and non-contrast brain computed tomography (CT) in the Emergency Department (ED). KEY FINDINGS: A narrative review explored relevant literature and key regulatory policy. Ten documents were identified, three main themes were developed related to the radiographer roles in X-ray request justification, dose optimisation and preliminary image evaluation (PIE). Radiographers were equally aware of justification and optimisation pre and post the introduction of a Medical Code of Practice. The collective PIE accuracy of radiographers remained unaffected by changes in mode of PIE delivery and regulatory factors but varied based on the anatomical region. CONCLUSION: While current Australian regulations mandate radiographer request justification, dose optimisation and PIE, the degree of compliance by Australian radiographers remains uncertain. Current literature provides evidence that radiographers can improve patient care and safety through justification, optimisation, and PIE delivery. Change in workplace practice, supported by key stakeholders including radiologists, is essential to integrate radiographers' functions into routine ED clinical practice. Further research is required to audit radiographers' regulatory compliance to improve patient safety. IMPLICATIONS FOR PRACTICE: Patient safety in ED can be improved with timely and accurate diagnosis provided by radiographers. Radiographers have a professional obligation to adhere to the capabilities and standards for safe medical radiation practice defined by Australian regulations. Therefore, radiographers must justify the X-ray request, optimise the radiation dose where appropriate and communicate urgent or unexpected findings to the referrer.

The role of the sonographer - An investigation into the scope of practice for the sonographer internationally.

INTRODUCTION: There is global variance in the role of a practicing sonographer. Literature examining global sonographic roles and scope of practice is limited, despite the international applicability of ultrasound imaging. This study aimed to examine the common and divergent features of a practicing sonographer internationally, and their impact upon the development of a global standard of practice. METHODS: An ethically approved mixed-methods online survey was conducted. The purposive sample included all 75 current elected council members of the ISRRT [International Society of Radiographers and Radiological Technologists], an international professional organisation. RESULTS: Thirty-six individuals from at least 32 different countries responded, reflecting the sonography profession in all four ISRRT regions. The results suggest that sonographer education requirements differ widely, from on the job training (16%, 6/36) to undergraduate or postgraduate schooling (44%, 16/36). Registration and accreditation bodies were present in the jurisdiction of 41% (14/34) and 35% (12/33) of respondents respectively, though many were voluntary, physician-focused or non-specific to sonographers. Five of 11 (45%) respondents suggested that the sonographer-radiologist relationship is individual-dependent, and not primarily positive or negative. Ten of 28 (36%) suggested that other professionals do not know the role of the sonographer. CONCLUSION: The majority of ISRRT council member respondents believe that an international scope of practice could benefit and be implemented in their jurisdiction (26/28, 93% and 22/33, 67%). The key advantages noted were standardisation of education and improved professional mobility. However, lack of sonographer education and radiologist acceptance are important potential barriers. IMPLICATIONS FOR PRACTICE: An international scope of practice could be beneficial and implementable in most ISRRT jurisdictions. Professional mobility and education standardization are the primary advantages. Insufficient sonographer education and physician acceptance are the key potential obstacles.

Regulation of healthcare and medical imaging in Australia: A narrative review of the evolution, function and impact on professional behaviours.

OBJECTIVES: This review explores the literature about the status and influence of statutory regulation in healthcare with a focus on medical imaging. It summarises the status of regulation in Australia for radiographers and sonographers, with brief reference to the global situation. The role of regulation is explored in terms of its evolution, function and effect on professional behaviours. KEY FINDINGS: Reports of medical errors, sentinel events and professional misconduct in healthcare have raised concern about how health care professionals are regulated. Patient-centric healthcare delivery has changed how people interact with healthcare, contributing to the development of statutory regulation for many healthcare professions. In Australia, the Health Practitioner Regulation National Law (The National Law) 2009, established the National Registration and Accreditation Scheme (NRAS) in order to practice. Not all health care professions are included in the scheme. In medical imaging, radiographers are included but sonographers are a notable exception. Regulation is designed to positively influence practitioners' professional behaviours. The available evidence however is limited, but suggests that under certain circumstances, it can negatively impact practitioners' professional behaviours. CONCLUSION: Statutory regulation has been implemented to address serious issues highlighted in reports of medical errors and professional misconduct, but it may have unintended consequences on the professional behaviours of practitioners. Limited research means the relationship between statutory regulation of healthcare practitioners and its impact upon professional behaviours remains unclear. IMPLICATIONS FOR PRACTICE: If statutory regulation of healthcare professionals is to achieve its aim of protecting the public, it is imperative that we understand the impact that it has on professional behaviours. This review highlights that it can negatively impact professional behaviours which may be detrimental to patient's safety.

Assessing the impact of country culture on the socio-cultural practice of radiography.

INTRODUCTION: Diagnostic radiography is a deceptively similar occupation regardless of country and yet there are wide varieties of scopes of practice, levels of autonomy, respect and understanding of what a radiographer does. METHODS: A socio-cultural comparative ethnographic study was carried out in seven culturally diverse countries observing and interviewing radiographers in one regional hospital in each country. The thick descriptions collected were thematically analysed. This article describes the comparison between work culture and country culture between the seven countries using the analytic device of Hofstede's cultural dimensions. RESULTS: The results demonstrate a wide disparity between countries, in importance of hierarchy, acceptance of individuality, ability to work autonomously and strength of country specific cultural norms. The impact of the country culture on the practice of radiography is manifested through variations in education, scope of practice, and level of recognition within the healthcare spectrum. CONCLUSION: These findings offer insight into the socio-cultural practice of radiography through an ethnographic cultural-specific lens and provide some explanations for the barriers evidenced currently to global recognition of standards and scopes of practice. IMPLICATIONS FOR PRACTICE: The study introduced empirical evidence into a subject matter hitherto unexplored in a global comparative manner, and creates an opportunity to improve the recognition of radiographers by creating a foundation of research upon which to build further more targeted studies.

Mandatory refreshment for nurses: an incentive to return?

The UKCC's proposal to introduce mandatory refreshment for nurses will affect all qualified nurses and those in training. This article reviews the advantages and disadvantages where similar changes have been effected. It discusses concerns to the individual and the profession and considers the implementation during a period of change.

Antihypertensive effects of acebutolol plus hydrochlorothiazide and hydrochlorothiazide alone in black patients.

Fifty black (Zulu) men, aged 20-60 years, with mild-to-moderate essential hypertension participated in a double-blind randomized parallel-group study lasting 12 weeks. Study drugs were acebutolol 200 mg plus hydrochlorothiazide 12.5 mg (Secadrex; Maybaker) (SDX) or hydrochlorothiazide 25 mg (HCT) given as a single tablet once daily under supervision. Following a 4-week washout period and after protocol exclusions and withdrawals, a total of 37 patients took the active preparations for 6 weeks, 33 for 7 weeks and 32 for 8 weeks. Of 17 patients treated with SDX, 16 responded satisfactorily; 20 patients were treated with HCT and 18 responded satisfactorily. No important biochemical or haematological changes occurred and no serious adverse reactions were noted. Mild-to-moderate essential hypertension was effectively controlled in a significant proportion of both treatment groups.