Australian College of Nursing
Recommendations from the Australian College of Nursing on peripheral IV catheters, blood glucose self-monitoring, antipyretics, urinary catheters & x-rays for ankle trauma. The Australian College of Nursing (ACN) is the national professional organisation for nurses in health and aged care settings. ACN provides nursing expertise to government and key stakeholders, and seeks to enhance the expertise of nurses when providing leadership and contribution to policy, practice and delivery of health care.
5.
Don’t initiate plain X-ray for foot and ankle trauma unless criteria of the Ottawa Ankle Rules are met.
Traumatic injury to the foot and ankle are a common reasons for presentation to the emergency department. The Ottawa Ankle Rules (OAR) are an effective screening tool to guide the use of plain x-ray in the evaluation of these injuries. Validation studies have found that the OARs have an almost 100% sensitivity in many studies in a number of clinical settings. The correct application of the OARs can identify patients who are likely to have a clinically significant fracture and reduce unnecessary use of diagnostic imaging resources by 30-40%.
Supporting evidence
- Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP & Wright RB. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Academic Emergency Medicine 2009;16(4): 277-287.
- Stiell IG, Greenburg GH, McKnight RD, Nair RC, McDowell I & Worthington JR. A study to develop decision rules for the use of radiography in acute ankle injuries. Annals of Emergency Medicine 1992;21:384-390.
- Sudhir S, Pankaj K & Prakhar, G. Application of ottawa ankle rule. International research Journal of Medical Sciences 2014;2(10):7-12.
How this list was made
The Australian College of Nursing (ACN) as nursing lead, established a collaborative working party incorporating a diverse range of nursing expertise. Professional nursing bodies involved in initial collaboration included: Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM); CRANAplus; Australian Primary Health Care Nurses Association (APNA); Australian College of Mental Health Nurses (ACMHN).
ACN’s membership was consulted via publications, web site and ACN’s National Nursing Forum. This consultation provided a broad view from our members regarding planning and delivery of nursing care across Australia. An interactive session invited delegates to actively participate in identifying those nursing practices, interventions, or tests that evidence shows provide no benefit or may even lead to harm. This informative stimulating session examined a range of nursing practices and their effects on healthcare consumers.
At this point specialist nursing groups were approached for comment on our recommendations. This group included: Australasian College for Infection Prevention and Control (ACIPC); Australian Diabetes Educators Association (ADEA); Continence Nurses Society Australia (CNSA); Australian and New Zealand Urological Nurses Society (ANZUNS); Medical Imaging Nurses Association (MINA); and the Australian and New Zealand Orthopaedic Nurses Association (ANZONA). Final consultation with ACN Members and Fellows prior to submission ensured a collaborative result.
- 1 Don’t replace peripheral intravenous catheter unless clinically indicated.
- 2 Don’t restrict the ability of people with diabetes to self-manage blood glucose monitoring unless there is a clinical indication to do so.
- 3 Don’t routinely administer antipyretics with the sole aim of reducing body temperature in un-distressed children.
- 4 Don’t use urinary catheters to manage urinary incontinence unless all other appropriate options have proved to be ineffective or to prevent wound infection or skin breakdown.
- 5 Don’t initiate plain X-ray for foot and ankle trauma unless criteria of the Ottawa Ankle Rules are met.