Improving the accuracy of Nurse Initiated X-ray Orders (NIXO) in the Emergency Department

Abstract

Purpose: In Sengkang General Hospital (SKH), Emergency Department (ED) triage nurses are privileged to order x-rays for patients prior to consultation with the ED doctors based on the initial presenting complaints. This workflow was implemented to improve the efficiency of patient management in ED. However, SKH ED radiographers encountered several orders from triage nurses that were deemed inappropriate or inaccurate. Such orders have led to several near-miss cases that could compromise patient safety and potential medico-legal issues. It also subjects patients to unnecessary radiation. This study aims to evaluate if using an educational tool can improve the accuracy of x-ray orders by ED triage nurses.Methods: Inappropriate or inaccurate x-ray orders are defined as x-ray orders that are ordered for incorrect region, incorrect side or inaccurate clinical history. An educational package in the form of presentation slides was created for the nurses by a team of radiographers. This package is called NIXO, an abbreviation of Nurse Initiated X-ray Orders. NIXO was then presented to the ED triage nurses during their monthly Continuing Professional Development (CPD) session in June 2021. With the assistance of the ED nursing education team, data for nurse's x-ray orders were obtained three months before and after the CPD session. The results of this data will determine the effectiveness of the NIXO presentation to the triage nurses.Results: Data was collected between April 2021 to June 2021 (pre-CPD) and August 2021 to October 2021 (post-CPD). It was found in the initial results that there is a drop in the x-ray orders error rates. This showed that there has been an improvement in the accuracy of ED triage nurse's x-ray ordering. In addition, in a post-CPD presentation survey conducted, 99% of the triage nurses found this initiative to be helpful in their clinical work. Collection of data is still ongoing up till February 2022. The results of this study will be evaluated once again in February 2022.Conclusion: Based on the preliminary findings of this study, it suggests that NIXO has helped reduce the number of inappropriate orders made by ED triage nurses. This inter-professional education initiative has provided ED triage nurses with the knowledge required to order X-rays competently whilst ensuring patient safety and providing care. As such, NIXO education package will be integrated into the ED triage course in future. Purpose: In Sengkang General Hospital (SKH), Emergency Department (ED) triage nurses are privileged to order x-rays for patients prior to consultation with the ED doctors based on the initial presenting complaints. This workflow was implemented to improve the efficiency of patient management in ED. However, SKH ED radiographers encountered several orders from triage nurses that were deemed inappropriate or inaccurate. Such orders have led to several near-miss cases that could compromise patient safety and potential medico-legal issues. It also subjects patients to unnecessary radiation. This study aims to evaluate if using an educational tool can improve the accuracy of x-ray orders by ED triage nurses. Methods: Inappropriate or inaccurate x-ray orders are defined as x-ray orders that are ordered for incorrect region, incorrect side or inaccurate clinical history. An educational package in the form of presentation slides was created for the nurses by a team of radiographers. This package is called NIXO, an abbreviation of Nurse Initiated X-ray Orders. NIXO was then presented to the ED triage nurses during their monthly Continuing Professional Development (CPD) session in June 2021. With the assistance of the ED nursing education team, data for nurse's x-ray orders were obtained three months before and after the CPD session. The results of this data will determine the effectiveness of the NIXO presentation to the triage nurses. Results: Data was collected between April 2021 to June 2021 (pre-CPD) and August 2021 to October 2021 (post-CPD). It was found in the initial results that there is a drop in the x-ray orders error rates. This showed that there has been an improvement in the accuracy of ED triage nurse's x-ray ordering. In addition, in a post-CPD presentation survey conducted, 99% of the triage nurses found this initiative to be helpful in their clinical work. Collection of data is still ongoing up till February 2022. The results of this study will be evaluated once again in February 2022. Conclusion: Based on the preliminary findings of this study, it suggests that NIXO has helped reduce the number of inappropriate orders made by ED triage nurses. This inter-professional education initiative has provided ED triage nurses with the knowledge required to order X-rays competently whilst ensuring patient safety and providing care. As such, NIXO education package will be integrated into the ED triage course in future.