X Ray Requests By Nurses 2020 02 18.pdf

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1.  Purpose of guideline
To ensure that patients receive appropriate radiological investigation in a timely manner.
2.  Scope
Nursing staff in The Adult Emergency Department (AED) who have successfully completed the limb
assessment study day.
3.  Recommended best practice
  Who will request X-rays?
  AED nursing staff who have completed the limb assessment X-ray-training programme study
day will be will be eligible to request X-rays.
  Nurses who are level 2 (or above) will be selected for this programme.
  Intended learning outcomes
The nurse will demonstrate knowledge and understanding of the following:
  Normal anatomy and physiology of the upper limbs (shoulder to hand) and lower legs (below
knee to foot).
  Awareness of inclusion/exclusion criteria of suspected # Neck of Femur Clinical Pathway.
  Indications for requesting X-ray.
  Contra-indications for requesting X-ray and the risk of unnecessary exposure to radiation.
  Tetanus – AED.

  Level of practice
  An ability to elicit an accurate history from the patient.
  Demonstrate comprehensive limb assessment, including initial management (first aid;
splinting, analgesia; icepacks).
  Identifies whether there is an indication for an X-ray.
4.  X-ray protocols
  Only AED nurses who have undergone training and have achieved the appropriate level of
competency may request X-rays.
  Only X-rays of the lower legs (below knee to foot) & upper limbs (shoulders to hand) may be
requested, and those patients identified on the AED # Neck of Femur Clinical Pathway
  Females of child-bearing age are asked if they are/could be pregnant. This needs to be
documented in the clinical data. Otherwise, their pregnancy status must be checked through a
urine beta hCG test. If the patient is pregnant, the decision to X-ray rests with the doctor.
  All patients must have a wristband.
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  Documentation
  Complete all the fields in ROERS radiology request on Concerto with all relevant and accurate
details. The requesting nurse’s name should be clearly identified.
5.  Audit tool
  Criteria
Criteria required for nurses requesting upper and lower limb X-rays:
Action
Yes
No
Requesting nurse’s name (Must have achieved competency)

Correct patient details entered/affixed

Clinical data

Subjective assessment conducted and documented

Objective assessment conducted and documented

Pregnancy state documented (females of child-bearing age only)

Question to be answered stated (on X-ray request form)

X-ray request stated (on X-ray request form)

X-ray request relevant to objective assessment

X-ray request documented in notes

First aid/management documented in notes

6.  Supporting evidence
  Chudleigh, J. (2004). Nurse requested X-rays in A&E department: Jane Chudleigh examines the
criteria employed by nurses in requesting X-rays, and the kind of training they may
require. Emergency Nurse, 11(9), 32-37.
7.  Associated documents
Auckland DHB policies and guidelines
  Professional Development and Recognition Programme for Nurses
  Tetanus Vaccine Booster Standing Order

Other
  Australasian Triage Scale 2001
  Suspected # Neck of Femur pathway
  AED Nursing Limb Assessment Module
8.  Disclaimer
No guideline can cover all variations required for specific circumstances. It is the responsibility of
the health care practitioners using this Auckland DHB guideline to adapt it for safe use within their
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own institution, recognise the need for specialist help, and call for it without delay, when an
individual patient falls outside of the boundaries of this guideline.
9. Corrections and amendments
The next scheduled review of this document is as per the document classification table (page 1).
However, if the reader notices any errors or believes that the document should be reviewed
before the scheduled date, they should contact the owner or Document Control without delay.

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