I get so sick and tired of this argument. Protocols are for guidance of
staff (generally junior)and identify usual best practice for that hospital
and in the spirit of them deviation is absolutely fine provided a
justification can be made (and documented if required). I dont accept I
require permission from another speciality to obtain a clinically indicated
investigation. Fortunately this isnt a problem where I currently work, but
it has almost driven me to tears of frustration in the past. Systems with
protocols require a certain degree of common sense on both sides and
frequently this is lacking (on both sides).My personal favourite is the "
Paediatric Foreign body " protocol which requires a lat neck / chest / abdo
films. For many it dosnt matter if the FB is found on the first film - we
still religiously get all 3 films - because the protocol says so !!! I
dispair.
rant over
Craig
>From: Vikki Chase <[log in to unmask]>
>Reply-To: Accident and Emergency Academic List <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: 5th metacarpal base fractures
>Date: Thu, 11 Apr 2002 22:52:55 +0100
>
>You are welcome to request such views, but the radiographer may have to
>refuse to provide them, depending upon locally agreed protocols. The
>radiographer ( in addition to the requesting doctor) is potentially liable
>when deviating from written protocols ( IRMER 2000 regs)- just because it
>is
>requested by a doctor ( or suitably qualified nurse) doesn't mean
>radiographers can do it. Where I currently work, we routinely provide
>lateral views for A and E requests if we spot something, otherwise only
>orthos can ask ( written protocol).
>Vikki Chase
>Diagnostic Radiographer
> -----Original Message-----
> From: Accident and Emergency Academic List
>[mailto:[log in to unmask]]On Behalf Of Ray McGlone
> Sent: 11 April 2002 22:30
> To: [log in to unmask]
> Subject: 5th metacarpal base fractures
>
>
> Lesson of the Week
>
> Some time ago a male patient presented with swelling and tenderness over
>the base of his 5th metacarpal (dominant hand) following trauma. A hand
>view
>was reported as being normal by the radiologist and doctor. Patient
>presented about 2 weeks later with continuing symptoms, he had a
>dislocation
>of the 5th metacarpal base. It was then successfully K-wired.
>
> These injuries are not uncommonly missed, I have a little collection in
>my
>library of films (usually picked up by the radiologist). If you are
>considering a dislocation of the 5th metacarpal base it is best to request
>a
>true lateral in addition to the other views.
>
> Any views?.. pardon the pun.
>
>
> Ray McGlone
>
> A&E Consultant
> Royal Lancaster Infirmary / Westmorland General Hospital
>
> http://www.mbha.nhs.uk/morecambe_bay_hospitals_trust.htm
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