Developing an advancednursepractitioner led scaphoidpathway

Sian Edwards andLouisaMorris

Background

Hand and wrist injuries are a common presentation to MIUs in the U.K, and scaphoid fractures account for 90% of carpal fractures. Up to 16% of scaphoid fractures are not visible on initial imaging (Bickley, 2019).

Amissed fracture carriesthe risk of avascular necrosis, leading to significant morbidity and costly corrective treatment, as well as the risk of litigation.

History taking, including mechanism of injury and time of injury is paramount.

Aim of Audit

To evaluate clinical standards by ENPs and GPs meet National guidance of potential scaphoid fractures.

To audit documentation standards to avoid any potential litigation against theHB.

Deliver teaching to GPs and ENPs about wrist injuries, history taking skills, anatomy and scaphoid fractures.

To set up an advanced nursepractitioner led soft tissueclinicanda scaphoid pathway to ensure gold standard of treatment to aidearlier diagnosis in MIU.

Methodology

A core working group established,led by an ANP. ANPled softtissueinjuryclinics were established.

Phase 2 results

Retrospective data analysis of wrist injuries (as phase 1)

Pdsa 2

Establish local MRI pathway for MIU

If scaphoidsuspected STI clinic 2/52

If still symptomatic and no obviousscaphoid fracture, request MRI MRI scan completed within 48hours

MRI report within 24hours (still in agreement stage)

Phase 3 results

Phase 1 results

Pdsa 1

The ANP team will address thiswith teaching the ENPs andthe GPs about wrist and hand injuries.

History taking skills

Anatomy and physiology of the hand and wrist

Clinical examination skills of the hand and wrist

Investigation, diagnosis and follow up processes

ENPs advised to audit their own clinical practice/documentation following the template used for this audit.