Application of Ottawa Ankle Rules - Case Study Example

Personal Case Study Reflection Name: Professor: Institution: Course: Date: Background Critical thinking strategies have been vital to improved performance of the nursing staff in the health care facility where I was personally involved as a nurse. The nursing staff unveiled a project, which it sought to implement in the United Arab Emirates (UAE). The research project intended to determine whether application of Ottawa Ankle Rules could help avoid unnecessary X-rays to verify if a patient had foot or ankle injuries. I particularly contributed in making the decision that saw the nursing staff settle on United Arab Emirates as the destination to conduct the study. Apparently, we realized that most health facilities in the UAE relied so much on the X-rays as the main equipment for determining whether an individual had fractures of the foot or ankle. This contributed to congestion and delays inside the emergency rooms (ER) with many patients waiting for several hours before they accessed the services. The Ottawa Ankle Rules (OAR) is one of the clinical decision analysis tools that seek to determine the need for an X-ray for patients with ankle injuries. The rules would determine the point at which medical practitioners subject patients of ankle injuries to X-rays. Apparently, X-ray is a perfect way of determining whether there are fractures in the ankle of the victim that could possibly require further treatment. The research undertaking also seeks to determine the validity of screening of patients in hospitals as one of the overriding applications of Ottawa Ankle Rules (OAR). The accuracy of the rules would mainly depend on the commitment of paramedics to implementation in the wake of technological advancements at the modern facilities. The capacity and usefulness of Ottawa ankle rules to assist with decision-making process is another important aspect the study seeks to underscore (Kodali & Anand, 2009, 57). Like other vital decision analysis tools am well conversant with, Ottawa ankle rules are essential to the thorough examination as well as taking the history of the patient as far as the injury is concerned. The study also intends to prove fallibility of Ottawa ankle rules just like other decision analysis tools. Apparently, the rules are also subject to some imperfection and unreliability that makes them produce inconsistent or sometimes misleading results. Implementation process revealed certain discrepancies that rendered the technique undependable since about 1000 patients that exhibited negative findings upon examination through application of Ottawa ankle rules, 14 of such patients showed signs of developing or have developed fractures. In essence, the technique would not be as perfect as many practitioners might have assumed. The study further seeks to establish the benefit of the OAR to the patient as well as health care economy considering that it allows patients to undergo assessments and treatment at the comfort of their homes without necessarily going to Emergency Departments (Kodali & Anand, 2009, 57). Triage Nurses Triage refers to the process through which injured persons are sort into groups according to their medical requirements and attention. Triage is employed in disaster sites, hospital emergency rooms or battlefields where restrained medical resources must be assigned. Developing nursing practice is a worldwide occurrence that has evolved over the past years. The evolution of advanced nurse practice is a constant procedure that helps in moving the nursing practice forward for the benefit of the patients (Fulde 2009, p.701). The change of practice is directly linked to shifts in the delivery of healthcare services and execution of new models of patient-centered care. A significant driver in the growth of advanced practice nurse is to achieve government-set performance pointers and standards directed at lowering emergency department waiting times and client’s length of stay besides raising the satisfaction of a patient. Another key aspect that has triggered the emergence of advanced practice is nursing and medical workforce shortages and skill mix issues (Vieth & Rhodes 2006, p. 787). These advancements have offered the impetus for emergency nurses to take on novel prospects to build and augment their complexity and scope of practice in the field of emergency medicine (Fulde 2009, p.702). The advanced nursing responsibilities are new duties that work with and add to the clerical and medical staff to accelerate the journey of a patient through the emergence department. Objectives of Triaging The journey of a patient in the emergency department starts at triage. Triage is a significant place in care delivery in all emergency departments. It is the point through which care starts. Triage is a short clinical assessment that determines the urgency of treatment and the time sequence in which patients should be assessed in the emergency room. The aim of the triage system is to guarantee safe care quality and equity of access to health care services (Fulde 2009, p.703). In all healthcare atmospheres, the triage procedure is strengthened by the premise that, a reduction in the time taken to access ultimate medical care will enhance the outcome of the patient. More significantly, triage is a constant and dynamic procedure through which patients are continually reexamined. Their clinical urgency and triage category may be changed depending on parameters, which include shifts in the level of pain augments and hemodynamic immovability. For instance, if a patient’s pain level rises compared to initial triage evaluation, or patients become hypotensive or tachycardic, the patient is re-triaged to a high category. Triage is the primary clinical tool for guaranteeing that patients are seen in a timely manner, proportionate with their clinical urgency (Fulde 2009, p.703). The practice application of the triage system is the procedure through which nurses assesses a patient who is presenting complaint, which is identified through a epigrammatic history of the presenting injury or illness. Triage decisions are created following observation of general appearance, physiological data and centered clinical history. This decision-making procedure may also call for discussion and consultation with medical staff. There are numerous elements for a nursing performing the role of a triage nurse, and they include: Assessment of patient Beginning of nursing interventions Guaranteeing constant reassessment and management of patient in the waiting room Provision of public education Performing as a liaison for the public and other healthcare professionals The capacity to perform efficient and effective triage is dependent on expansive knowledge of and experience with a wide range of illness and injury blueprints. As a result, the triage nurse must be suitably prepared via experience and education. The triage nurse performs a seven-step triage assessment, which determines the following major points as physiological predicators underlining the allocation of urgency (Lee & Maleski 2002, p.254). The steps include: Identification and management of risks to patients, self and the environment Making triage decisions after consideration of the first impression of general appearance Assessing the patient sickness issue Identify and correct life-threatening conditions at triage through a thorough primary survey perspective Detection of other conditions through which timely intervention may considerably influence the outcome of the patient Enhance patient outcome through allowing timely access to emergency care Inform focused ongoing medical investigation and assessment through early determination of physiological abnormality at triage. The advance practice roles help in expediting treatment and starting of care (Fulde 2009, p.704).According to O’Connell (2004, p.2158), triage nurses collect vital signs and medical history. O’Connell further affirmed that triage comprises of provision of basic first aid, which may entail bleeding control, application of ice, and general wound care besides initiation of protocol-founded orders such as X-rays, Mild analgesics, urinalysis, removing sutures and administration of antipyretics (O’Connell 2004, p.2158). The triage nurse is also accountable for and monitors the waiting room, upholds a safe atmosphere and reassesses waiting patients. Triage Decision However, routine emergency department triage protocols differ considerably from the triage protocols utilized in disasters and mass casualty incidents. Routine triage directs all accessible resources to the patients who are critically sick, notwithstanding the potential upshots. In field triage or hospital triage in the course of a disaster, scarce resources must be utilized to benefit the most people possible. This difference affects triage decisions. For patient assigned to an emergent, urgent or a resuscitation category, stabilization, prompt transfer to the suitable setting and provision of critical treatments are major priorities of the emergency care. Although treatment is initiated in the emergency department, continuing classic treatment of the underlying issue is offered in other settings, and the sooner the patient is stabilized and moved to that area, the better the upshot. A systematic perspective to productively establishing and treating health priorities is the principal survey or secondary survey perspective. The primary survey centers on stabilizing life-threatening issues. The emergency department work jointly and follow the airway breathing, circulation and disability (ABCD) method (Olive 2003, p.28). Upon assessment, testing and stabilization of patient, suitable medical and nursing diagnoses are generated, initial and significant treatment started and plans for the appropriate disposition made. Besides, management of injury and illness, the emergency department nurse focuses on offering comfort and emotional support to the patient and the patient’s family. Effective pain management must be established early, and should entail rapid-acting agents that lead to minimal sedation so that the patient can persist to interact with the staff for constant assessment (Yoon, Steiner & Reinhardt 2003, p.158). Moderate sedation facilitates short procedures in the emergency department whereby the patient get closely monitored in the course of the process and then awakened when the procedure is over. Eligibility of the patients According to some studies, a larger percentage of the people who have ankle injuries do not have a fracture. From the assessment of work done by previous authors, out of an estimate of 98% of patients who report to an emergency room with ankle injuries, only less than 15% have a significant fracture in their ankle (Jenkin, p. 3, 2010). Since it is costly to conduct these radiographic imaging, there are recommendations from Dr. Ian Stiell on the types of patients that should undergo the imaging. This would go a long way in ensuring that the cost of conducting this examination significantly reduces (Jenkin, p. 3, 2010). Some of the patients who should undergo the imaging process include patients who cannot walk for a few steps because of the pain in their ankles and those whose bones are tender at the inferior tip of the lateral malleolus (Jenkin, p. 3, 2010). For inclusion in that category are patients who are 55 years old or older and also the patients who have a tender bone at the posterior edge of the medial malleolus (Jenkin, p. 3, 2010). The Ottawa ankle rules do not apply to all categories of patients. Some of the patients who are excluded from these rules include pregnant women, patients who are under the age of 18 years, those who have some chronic injury, which might have lasted for ten days or more and the patients who have injuries on the skin, injuries like burns or abrasions. Ottawa ankle rules Since it is necessary to produce 100% success, following these rules in the determination of the eligibility for radiography is vital. The first thing to do for the best management of an ankle injury is to try to make an accurate diagnosis of the injury (Doral, p. 622, 2012). This should be the goal of diagnostics. There are some specific rules that should guide the imaging, which is necessary for ensuring that the patient does not get unnecessary exposure to radiation. By minimization of the exposure to radiation is vital for giving help to the triage in the hospital. The nurses can easily be able to determine the extent of the injuries, giving them the classification that they deserve. This classification makes it possible for the medical attendants to give the most appropriate response to the injury (Nyska & Mann, p. 78, 2002). The rules also make it possible for the patients to spend less time in the triage as they wait to get the most appropriate treatment. The Ottawa ankle rules are necessary for getting the most satisfactory treatment. It would be difficult to miss any kind of fracture when carefully using the rules (Harrison, p. 159, 2009). Physicians should use the Ottawa ankle rules as a guide for the determination of the type of patient to undergo the radiographic imaging. Apart from using the rules, there are instances where the physician has to use his or her common sense in the determination of the eligibility of the patient (Stiell et al, p. 389, 1992). The physician should be able to be certain about the decision that he or she is taking in regard to the administration of the correct measures in dealing with the patient. The physician can be able to make the correct judgment because of experience, but common sense is vital. By looking at the extent of the injury, it is possible to come up with the most appropriate method to handle it. It would be beneficial to consider the Ottawa ankle rules before providing treatment to the patient. Diagnosis It is vital to first delineate the clinically significant pathology and one that is not so significant. The goal of the diagnostics should be to the provision of an accurate and more specific diagnosis on the type of injury for the best treatment (Doral, p. 623, 2012). At the diagnosis, it is vital for the attendants not to assume that everything that is not a fracture is a sprain. When conducting the diagnosis, the rules that the attendant should consider include the examination of bone tenderness at the posterior edge or at the tip of lateral malleolus, or the medial malleolus (Doral, p. 622, 2012). The other determinant that might show if the patient needs an exposure to radiation is his or her ability to stand on the injury. If the ankle cannot bear the weight of the injured patient, both after getting the injury and while on treatment, then it would be advisable for the imaging to determine the extent of the fracture. References Wartick, M.L. 2004, "Legislative justification and the perceived fairness of tax law changes: A referent cognitions theory approach", The Journal of the American Taxation Association, vol. 16, no. 2, pp. 106-106. Dolan, B 2008, Accident and emergency: Theory into practice. London: Elsevier Health Sciences, Stiell, I.G., Greenberg, G.H., McKnight, R.D., Nair, R.C., McDowell, I. & Worthington, J.R. (1992). A study to develop clinical decision rules for the use of Radiography in acute ankle injuries. Annals of Emergency Medicine, 21(4), 384-390 Stiell, I.G., Greenberg, G.H., McKnight, R.D., Nair, R.C., McDowell, I. & Worthington, J.R. (1992). A study to develop clinical decision rules for the use of Radiography in acute ankle injuries. Annals of Emergency Medicine, 21(4), 384-390 Read More