Abstract
We undertook a retrospective audit to assess quality of service provided by Nurse-Led Review Clinic at Glasgow Royal Infirmary for patients sustaining ankle fracture requiring surgical stabilisation. Nursing staff had received training from the senior author regarding clinical examination and radiograph interpretation.
We retrospectively reviewed the clinical documentation and radiographs of 104 patients who attended from January 2009 to December 2009. Any clinical issues were identified and radiographs were scrutinised by two of the authors to assess accuracy of interpretation. Nurse-led management was then assessed as to its appropriateness. Finally two retrospective questionnaires were used to assess both the nurses and patients satisfaction with the clinic.
Nurse-led clinic protocol: First appointment 10 days: Wound review, application of lightweight plaster. Second appointment 6 weeks: Removal of plaster, check radiographs. Final appointment 12 weeks: Clinical assessment, radiographs, discharge. Clinical assessment: ensure wound satisfactory, range of movement and weight-bearing are improving. Radiographic criteria: 6 weeks: Assess for talar shift, lucency or metal-work concerns. 12 weeks: Assess evidence of fracture union, infection, loosening or backing out. If any concerns with the patients' progress nursing staff would discuss with the consultant.
First appointment: 7 wound problems. 5 managed by nurses and resolved. 2 discussed with surgeon, 1 settled, 1 required oral antibiotics. 3 radiographs discussed with surgeon. 2 conservative management. 1 re-operation. Second appointment: 7 wounds managed by nurses. 1 failure of fixation, discussed for re-operation. 2 concerns regarding metal in joint – treated conservatively. Final appointment: 7 referred to physiotherapy as slow to fully weight-bear. 5 discussed for removal of syndesmosis screw. 1 screw in joint, admitted for re-operation.
Clinical care provided at Nurse-Led clinic is appropriate and effective. Both nursing staff and patients were satisfied with the care provided. Nurse-led clinic reduces demands on fracture clinic appointments and is a safe, cost effective initiative.
