ANKLE AND FOOT X-RAY ORDERS - STANDARDIZED NURSING PROCEDURES

Effective Date: 
Wed, 09/01/2010
Reviewed: 
Sat, 08/27/2011
Revised: 
Sun, 08/28/2011

This standardized procedure uses the Ottawa Rules for x-ray of the Ankle and the Foot as guidelines to allow the RN to order x-rays prior to clinician appointment when the patient meets the established criteria. In a meta-analysis, the Ottawa Rules for x-ray of the Ankle had a 97.6% sensitivity and reduced the unnecessary use of x-rays by 34%.
Procedure
RN orders x-ray of the ankle if the patient meets the following criteria
 Bone tenderness at posterior edge or tip of the lateral malleolus OR
 Bone tenderness at posterior edge or tip of the medial malleolus OR
 Inability to bear weight both immediately after trauma and in triage.
RN orders x-ray of the foot if the patient meets the following criteria
 Bone tenderness along the base of the fifth metatarsal
 Bone tenderness at the navicular bone OR
 Inability to bear weight both immediately and in triage
Experience, Training and/or Education
Current California RN license
Completion of UCSC orientation specific to this procedure
Evaluation of Competency
Initial Competency
 RN observes experienced RN using the Ottawa Rules.
 RN demonstrates application of these rules under direct RN supervision at least three times.
 Clinic Director reviews 5 charts in which RN applied the Ottawa Rules.
On-going Competency
Chart reviews of this procedure occur as part of the on-going Quality Assurance program of the UCSC Student Health Center.
Scope of Supervision
No direct physician supervision required. Clinician provider available as needed for consultation.
Criteria for Provider Consultation & Referral
 Patients whose injuries do not clearly fall within these parameters are to be evaluated by a clinician prior to any radiology studies.
 Patients with altered mental status, altered sensation, particularly inability to passively move the foot and/or patients with multiple injuries are to be seen by a clinician prior to any radiology studies.
Documentation
RN documents according to the standards delineated in the UCSC Student Health Center Policy on Documentation of Care.