Some that I can remember form our dept (large teaching hospital in Syd)
Paed - AXR supine and in suspension
Adult - CXR with O2
Adult - CXR + inspiration
Teenager - xray left leg, left knee, left tibia, left ankle
Adult - xray left wrist and metacarpals
The classic
Adult - CXR - ap and lat chest pain
Isn't a pa better ?
Adult - AXR - supine and erect ? AAA
Scary yes, what do we do, just laugh and add to our request of the week list
But most of this is more proof that we need to take a more active role in the requesting of x-rays
PS love that first one and had me stumped for days, see who can guess what they meant
At 01:53 PM 14/11/2002 +1100, you wrote:
From: "Leo Klein" <[EMAIL PROTECTED]> Hello Izan, Some request forms that claim to be true.Not from nurses but from doctors. LJK Actual Medical Chart Notes1.. Patient has two teenage children, but no other abnormalities. 2.. Patient has chest pain if she lies on her left side for over a year. 3.. On the second day, the knee was better, and then on the third day it disappeared. 4.. The patient is tearful and crying constantly. She also appears to be depressed. 5.. Discharge status: Alive, but without my permission. 6.. Healthy-appearing decrepit, 69-year-old male, mentally alert but forgetful. 7.. The patient refused autopsy. 8.. The patient has no previous history of suicides. 9.. Patient has left white blood cells at another hospital. 10.. Patient's medical history has been remarkably insignificant with only a 40-pound weight gain in the last three days. 11.. She is numb from her toes down. 12.. Occasional, constant, infrequent headaches. 13.. I saw your patient today, who is still under our car for physical therapy. 14.. Skin: somewhat pale but present. 15.. The patient has been depressed since she began seeing me in 1993. ----- Original Message ----- From: "Izan Gill" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, November 14, 2002 1:26 PM Subject: Re: [AIRNEWS] Role extension? > From: "Izan Gill" <[EMAIL PROTECTED]> > > In RR areas there is a sort of generic NIXR procedure as very often the problem is not queues of people waiting but the fact that the sole hospital doctor is in OT, Maternity or, if part time, at the surgery. The OPD/ A&E nurse triages the patient if the Dr. is unable to attend and then takes direction from there over the phone. The examination requested will be along the llines "fall off ladder at work" and the verbal addition will be "whatever you think is best". Falls for NOF are included, very few CXRs, but not MVAs of course, paediatrics other than limbs or very young paeds. One of the advantages for the nurses is that in a small community, the patient is probably well known over the years. The nurses are normally very good at this (at this hospital anyway) as they tend not to move away once they reach the stage of being in charge of a Dept. even though the staff numbers are very small. Radiologists are an unknown breed out here - face to face at least. The team feeling and involvement is excellent and the Radiographer's opinion is sought and valued - at least by the hospital staffand some of the GPs. I never know whether to laugh or spit when GPs treat me as a number (not needing clinical details or previous films etc.) but follow on with "if you see anything let me know". So far laughter has triumphed. > > > Izan Gill > > >>> [EMAIL PROTECTED] 11/14/02 11:33am >>> > From: Alex Craven <[EMAIL PROTECTED]> > > Just thought I'd share an instance where NIXR seems to > work: > > This is a large hospital where NIXR has been in place > in the ED for some time, and seems to be working. > > The nurses can only request views distal to the knee > and elbow. Though some nurses are very good, generally > they seem to over-order and the incidence of ordering > the wrong body part is significantly higher than with > the Drs. Also, the clinical notes are often of very > poor standard (though that applies to a lot of DRs). > > However, it is generally assumed that the radiographer > will take responsibility for the examination > performed. The radiographer performs the > examination(s) she or he finds most appropriate then > notes and initials any alterations to the original > order on the request form. The radiologist is > consulted if it is deemed necessary, and it is well > with in the radiographers' rights to seek approval > from the radiologist to cancel the examination > completely (isn't often necessary, but it does > happen). > > The 'clinical examinations' we perform are only aimed > at localising pain/swelling/other symptoms, and is > really no different from what most radiographers do at > the start of a procedure anyway. As you know patients > often give a lot of information during the procedure > (previous injuries, underlying conditions etc) and > some of us have also started adding anything of > particular relevance that isn't in the clinical notes > (with initials so the radiologist knows it was us) or > putting arrows on films to show the location of > lacerations, tenderness etc. > > I'm not sure if all of this is the formal system > originally introduced for NIXR at this hospital, in > fact I doubt very much that this follows the procedure > exactly (it works too well!) > > >From a patient-care viewpoint this system is much > quicker than waiting for a DR, but seems to avoid the > disadvantages I've been hearing about at other > hospitals. Ie radiation safety and the appropriateness > of examinations are still given the attention they > deserve. > > Another advantagous change I see occuring is in the > relationship between radiographer and radiologist. The > little notes and consultations here and there seem to > remind both that the radiographer may have relevant > information that is not conveyed in the images > produced. I see radiologists stepping out of the > office to ask radiographers patients where clinical > notes are innadequate, more often than in any other > place I have worked, and not just for NIXR patients. > It's not as if every second case is discussed (may not > happen at all some days) but it is good for the > patient, allows the radiologist to do a better job, > acknowledges the radiographer as more than just a > pusher of buttons, and generally makes for a more > pleasant working environment. > > Sorry I couldn't be more succint, > > Alex > > PS - Please note that I cannot compare this to the > pre-NIXR system (only those at other hospitals I have > worked at), and these are my views (not necessarily > those of the people organisation I work for). > > > --- Dieter <[EMAIL PROTECTED]> wrote: > > From: Dieter <[EMAIL PROTECTED]> > > > > We have a similar situation going on at our > > institution at the moment. The > > NIXR is trying to be introduced but the ED got it > > wrong when they put in > > the nurse procedures the comment "if in doubt x-ray > > it" > > > > Needless to say the fan was on full blast...... > > > > I think if the radiographer profession is going to > > grow and not be swept up > > by other professions, we need to expand our role and > > take more > > responsibilty in our job. We have had it too easy > > too long, with not > > having to think that hard and then running to the > > radiologist for back up > > as soon as things get slightly out of the norm. > > > > If we as a profession really want to put a hold on > > the whole NIXR concept, > > (which many rads want to do) we will have to step up > > to the plate and start > > clinically assessing the patients to determine which > > x-rays we are going to > > take. It will have to become, > > clinician/nurse/patient thinks that the > > patient might need an x-ray and sends the patient to > > us, we then decide > > which and how the x-rays will be taken and then > > provide an interim > > report. Obviously there will need to be additional > > training needed by the > > current MRS's and more will ahve to be introduced > > into the universities' > > course work, but if it will guarantee the > > continuation and expansion of our > > profession, then it will have to be done. > > > > The biggest issue that will confront an expansion of > > roles such as this, is > > the treading on the toes of the radiologists. This > > will start to blur the > > lines between tech and Dr, and DR's don't tend to > > take too kindly to this. > > > > Are we up to it ? > > > > Interesting times ahead, but we will have to > > determine where we are going > > to go soon as NIXR's are well and truly getting > > their claws in. > > > > Dieter > > > > > > > > At 12:49 PM 13/11/2002 +0800, you wrote: > > > From: Rob Hart <[EMAIL PROTECTED]> > > > > > >The following is a small extract from a larger > > discussion on the ACEM list > > >in relation to nurse-initiated XR (NIXR). > > Interesting reading! My posting is > > >at the bottom, with the ED director of a large > > Eastern States hospital's > > >reply above. > > > > > > > > > >Brilliant > > > > > > > >In fact I did suggest at St Matyrs when NIXR > > came in & there were > > > >problems with a colleague encouraging them to ask > > for multiple areas in > > > >case they missed the wrong one & a lot of > > problems with suboptimal > > > >imaging (half of a Jones # on ankle xray, > > injured wrist right on the > > > >edge of a 30cm long film of forarm etc) that > > the nurses should stop > > > >at recognising probable need for xr and ask the > > radiographer to > > > >determine which xrays to take. > > > > > > > >It was the radiographers who refused. > > > > > > > >Similarly, when I managed (took a year!) to > > introduce provisional > > > >xray reports by the clinician so the radiologist > > would know when we'd > > > >screwed up & notify us early, I tried to > > persuade the radiographers > > > >into the "redspot" system. They were a really > > nice bunch of people, but > > > >chickened out - head radiographer says that's > > giving them clinical > > > >responsibility & they don't want it. We had at > > that stage a lot of > > > >shifts covered only by juniors; I think the > > system is useful there. > > > > > > > > > > > > > > > >>At 04:36 PM 12/11/2002 +0800, Rob Hart wrote: > > > >>Dear All > > > >> > > > >>Perhaps I can put in a spoke here for the > > radiology depts. I am hopeful > > > >>that all, with or without NIXR, rely on the > > professional opinion of > > > >>their medical imaging staff (radiographers as > > were) in determining the > > > >>relevant imaging to be performed. I know when I > > was at Royal Perth ED > > > >>for 5 years as a diagnostic radiographer, we > > considered ourselves part > > > >>of the decision-making process even though we > > are not entitled to > > > >>"order" (we prefer "request", but let's not get > > pedantic!) imaging exams > > > >>ourselves. In many cases we have seen many more > > of a particular #, > > > >>strain, sprain or other musculoskeketal injury > > than the refering intern > > > >>or RN/CN. This applies both to initial > > presentation, and to follow-up > > > >>zapping based on the results of the first series > > performed. Or is this > > > >>as polarised an issue (Dr initiated/NIXR) as it > > appears from the > > > >>outside? > > > >> > > > >>Regards to all > > > >> > > > >>Rob Hart > > > > > > > > > +=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+= > > > This message is being broadcast by AIRNEWS, > > > the Australian Institute of Radiography list > > Server > > > > > > Send messages to [EMAIL PROTECTED] > > > For assistance send mail to > > [EMAIL PROTECTED] > > > Commands should be sent to > > [EMAIL PROTECTED] > > > > > >Opinions expressed on this list are not necessarily > > those of the > > >moderator, his assistants or those of the A.I.R. > > > > > > > > > > +=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+= > > This message is being broadcast by AIRNEWS, > > the Australian Institute of Radiography list Server > > > > Send messages to [EMAIL PROTECTED] > > For assistance send mail to > > [EMAIL PROTECTED] > > Commands should be sent to > > [EMAIL PROTECTED] > > > > Opinions expressed on this list are not necessarily > > those of the > > moderator, his assistants or those of the A.I.R. > > > ===== > Alex Craven > Ph. 0407-685-319 > Email: [EMAIL PROTECTED] > > __________________________________________________ > Do you Yahoo!? > U2 on LAUNCH - Exclusive greatest hits videos > http://launch.yahoo.com/u2 > > > +=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+=+= > This message is being broadcast by AIRNEWS, > the Australian Institute of Radiography list Server > > Send messages to [EMAIL PROTECTED] > For assistance send mail to [EMAIL PROTECTED] > Commands should be sent to [EMAIL PROTECTED] > > Opinions expressed on this list are not necessarily those of the > moderator, his assistants or those of the A.I.R. > > > ********************************************************************** > This e-mail, including any attachments sent with it, is confidential > and for the sole use of the intended recipient(s). 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