GUIDELINE 4: Ordering Diagnostic Tests

Only the diagnostic tests that are clearly identified in the CST in a specific clinical practice area can be ordered by the RPN authorized to prescribe Schedule 1 drugs or order diagnostic tests.

Diagnostic test results can support safe and appropriate RPN prescribing decisions. See Appendix A for a list of common diagnostic and medical radiography tests that can be included in a CST. An RPN might order diagnostic tests to:

• ensure the medication and dose ordered are congruent with expected therapeutic responses;
• monitor the response of the client to the medication therapy to ensure optimal outcomes;
• monitor for adverse effects to ensure client safety; or screen the client for certain conditions

RPNs are not authorized to order any form of ionizing radiation in nuclear medicine or radiation therapy, non-ionizing radiation in lithotripsy or magnetic resonance imaging, or tests requiring radiopharmaceuticals or imaging contrast.

If the CST includes ordering diagnostic tests, the RPN authorized to prescribe, and order diagnostic tests will have to apply for a practitioner identification number (PRAC ID) through Alberta Health. Please contact CRPNA for further information on the need for a PRAC ID at [email protected].

When ordering diagnostic tests, the CST must be in alignment with the College of Physicians and Surgeons of Alberta’s Continuity of Care standard of practice (CPSA, 2015). The review, follow-up, process, and documentation of the diagnostic test(s) must include:

• a process to ensure that the diagnostic test was not already ordered or done to avoid duplication;
• a process to ensure accurate client contact information and an alternative contact method are obtained,
• who is responsible for receiving and reviewing the test results in a timely manner,
• who will be interpreting the results;
• what arrangement is in place for receiving and responding to critical diagnostic test results reported after regular working hours or in the RPN’s absence including:
  • ensuring that the laboratory or imaging facility is able to reach the RPN or designate,
  • the after-hours emergency number that will be provided, and
  • clearly identifying on the test requisition when the results are expected to fall in the critical range;
• who will be communicating the test result and any follow-up care with the client;
• who will be providing the follow-up care;
• what additional health-care professional review is required and any required communication between healthcare providers;
• who will follow-up when diagnostic tests results are not received within a period of time equal with the urgency of the investigation; and
• how the RPN will refer clients for any needed follow up or treatment.

There must be a clear responsibility for the follow-up of diagnostic tests and CRPNA requires the CST to outline the relationship between the RPN role and any other healthcare professional involved to ensure the seamless provision and continuity of client care. Good communication between health-care professionals and the client is vital to continuity of care and quality client care (CPSA, 2019).