Improving nurse initiated X-ray practice through action research

Area of Science:

• Emergency Medicine
• Radiology Nursing
• Healthcare Quality Improvement

Background:

• Emergency Departments (EDs) face increasing patient demands, leading to expanded roles for registered nurses in requesting diagnostic imaging.
• Nurses with specialized training now initiate X-ray examinations, necessitating clear practice guidelines.

Purpose of the Study:

• To evaluate existing nurse practice guidelines for requesting X-rays in the ED.
• To implement improvements in nurse-initiated X-ray (NIX) requests using inter-professional learning and change management theory.

Main Methods:

• A review of 301 nurse-initiated X-ray (NIX) requests assessed guideline adherence and clinical history quality (January-March 2012).
• A collaborative educational intervention based on inter-professional learning and change management theory was implemented.
• A second review (February-April 2014) evaluated the intervention's impact on NIX requests.

Main Results:

• Adherence to NIX guidelines significantly improved post-intervention (48% to 90%, P > 0.001).
• The quality of clinical history provided in NIX requests showed significant improvement across all essential criteria: mechanism of injury, injury location, side of injury, and clinical question.

Conclusions:

• Inter-professional learning and change management theory effectively enhanced the practice and support of nurse-initiated X-rays in emergency settings.
• The study highlights a successful model for improving diagnostic imaging request processes led by nurses.