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Objectives To estimate the potential reduction in waiting times for patients resulting from triage nurse‐initiated X‐rays. To compare the pattern of X‐ray ordering by triage nurses and medical staff. To estimate the accuracy of triage nurse‐initiated X‐rays. Method Prospective, blinded descriptive/comparative study with nursing intervention on an ‘intention to treat’ basis. Results Triage nurse‐initiated X‐rays would have identified 96% of fractures. Nurses would have ordered fewer X‐rays than doctors with an efficiency rate (number of fractures/number of X‐rays) of 41% compared with 36% for doctors. A conservative estimate of the potential time saving for patients is an average of 46 minutes. Conclusion Triage nurse‐initiated X‐rays should result in reduced waiting times for patients and increased efficiency of medical staff. This study suggests that this procedure would be accurate and efficient.

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Western Hospital FootscrayIt came to our attention, during a review of our poUcy and procedures regarding titrated intravenous narcotic administration for pain control, that neither the ampoules of morphine and pethidine nor the fluid used to dilute them contain preservatives. Thus, if multiple doses were administered from a syringe over time, this could pose an infection risk.A sample of 74 partly-used narcotic solutions was cultured in enriched medium, to test the hypothesis that the solutions remained sterUe. This method did not allow quantitation of any contaminant. Ten returned positive cultures. Five of these were coagulase-negative staphylococci, two diptheroids and one each P. acnes, bacillus species and E. coli. Follow up of the patient records revealed that eight failed to show any evidence of infection either at the intravenous site or systemically, ie a fever or a clinical infection. One had an established, partially-treated, urinary tract infection at presentation but did not develop fever, a raised white cell count nor intravenous site infection. The related narcotic specimen grew a different organism from that found in the urine. One patient admitted with chest pain, developed a clinical chest infection within 24 hours of admission, although blood and sputum cultures failed to identify a pathogen. The related narcotic fluid sample grew £. coli of uncertain significance.This preliminary study suggests that solutions used to administer titrated doses of narcotic analgesia may not remain sterile. Although our data does not demonstrate any adverse outcome in patients with positive culture specimens, contaminated specimens could theoretically pose a serious threat to susceptible patients. Current research is looking at the influence of preparation methods, nursing practice and storage times on the presence and level of contaminants in these solutions and on patient outcome.