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Show Ottawa Rules Implementation in Emergency Medicine Triage David Cluff, BSN, RN, DNP Student PURPOSE (or AIMS) Aims: Provide evidenced based guidelines for x-ray of lower extremity injury Reduce unnecessary x-rays in the ED Prevent unnecessary radiation damage to patients ~119,815 lower extremities injuries are reported yearly: Ankle 20% Knee 16% Foot 15% Many lower extremity injuries that occur are strains and sprains, accounting for 43-72% of injuries (Lambers et al., 2012) ~30% of patients receive unnecessary radiographic imaging (Yao & Haque, 2012) Ottawa rules are an effective tool with a high sensitivity of ~90% (Derksen et al., 2015) Methods: Ottawa Guideline education of ED RN Staff was conducted during an ED RN staff meeting. Pre & post test knowledge scores were compared using t-test Ottawa Foot and Ankle Rules: 44-55-66-PM – a pneumonic for use with Ottawa Foot and Ankle Rules •44 = Patient is unable to take 4 or more steps immediately after injury or in the ED •55 = Patient experiences pain in the 5th metatarsal or 5 caphoid/navicular bone of the foot •66 PM = Patient has pain in the last 6cm of the lateral or medial Posterior Malleolus of the tibia or fibula (Gravel, Roy and Carriere, 2010) Purpose: Develop and implement evidenced based guidelines for rapid assessment of lower extremity orthopedic injury at a government-run emergency department to promote responsible use of radiology BACKGROUND METHODS/RESULTS OTTAWA RULES Number of x-rays for 2 weeks pre and 2 weeks post education was collected using relevant ICD-10 codes and were compared using t-tests Ottawa Knee Rule: • Age > 54 years old • Isolated tenderness at head of fibula • Inability to flex the knee to 90 degrees • Inability to bear weight for 4 or more steps (Anderson, 2016) X-rays Ordered For 2 Weeks Pre and Post Intervention Pre-intervention Post-intervention 1 1 0.9 0.9 0.8 0.8 0.7 0.7 0.6 Pre-intervention 0.6 0.5 0.5 0.4 0.4 0.3 0.3 0.2 0.2 0.1 0.1 0 0 1 Post-intervention 1 Acknowledgements Nancy Allen, PhD, ANP-BC, Project Chair Denise Ward, DNP, ACNP-BC, FNP-BC, ACGNP Program Director Pam Hardin, PhD, RN Associate Dean for MS and DNP programs David Pease, Emergency Department MD, Content Expert Results: RN Demographics: twenty-three triage RNs, a majority of female (53%), aged of 52.9 (SD ± 13.4) years and a majority with a bachelor’s degree • Education pre-test mean 4.83 (SD + 1.85) and post test 7.91 (SD + 0.29) on an 8 pt. scale p-value = 0.001 showing results were significantly different Patient Demographics: seventeen male patients aged 71 (SD ± 9.8) and the majority Caucasian • ICD 10 codes 2 weeks pre-education were 66% (5/9, SD + 0.517) and post-education were 50% (4/8, SD + 0.29) with a p= 0.52 showing results were not significantly different CONCLUSIONS/IMPLICATIONS Triage RNs can be effectively taught and understand Ottawa rules for implementation in Emergency Medicine X-rays ordered were successfully reduced in this study, despite lack of statistical significance |
