Nurses taking patient's off backboards without doctor clearnce? - page 10

The place I am currently working takes their patients off the back bard before the doctors clear the pt. Dose anyone know or heard of this practice anywhere and what studies have done to backed this... Read More

  1. by   MassED
    Quote from CraigB-RN
    I have to disagree. There is plenty of information out there that shows the majority of patient placed on backboard don't need to be on them. If your taking them off the backboard, you need to have witten policies covering you. You ned to cover things like documentation, distracting injuries, ETOH and such. It can be safe, if your doing it right.
    as long as you are maintaining C-spine and log roll your patients, while a nurse who knows how to run a back is palpating, then there isn't a problem. I will run a back. I'm TNCC trained and this is also a part of that. If there's tenderness, step-off, etc., then we keep the person supine, as would a doctor. If it's crazy and there are traumas and a doctor can't get to a person for a while, we certainly will run the back and let the doc know our assessment.
  2. by   MassED
    Quote from RN1980
    now i guess thats a slander on our ems system here in poor ole mississippi...gosh darn..heck it's a wonder that folks survive down here. in the real world i'm not a dutch rn...and i don't know nothing of 110hrs of protocols, i'm a asn degree icu/er rn with ccrn and studying for cen..1lt in army nurse in ms nat. guard, thats right 2yr nsg degree..i guess here in mississippi they figure we can learn in 2 yrs what it takes ya'll 4 yrs to learn. and futhermore our hospitals have indoor plumbming in mississippi..
    Would you mind not to write in code and text, please? It's difficult to read and interpret. I realize this is an old post, but still....
  3. by   MassED
    Quote from RN1980
    again i reinterate, if you take upon yourself to clear a patient from a spinal package "no matter how long they have been on the board" and the patient suffers any deteriation from that action, you will be held liable in court, all the tncc and phtls courses that you've been to will not save you from being slam dunked...now i can't speak of the laws in england but here in the usa you'd be screwed. all you young er nurses out there pay heed...
    Us ER nurses can be held liable for many things, least of which is on how to maintain C-spine/log roll. If you're trained in an intervention, you practice accordingly.
  4. by   Esme12
    Quote from MassED
    Us ER nurses can be held liable for many things, least of which is on how to maintain C-spine/log roll. If you're trained in an intervention, you practice accordingly.
    You do know that this thread is 6 years old. AN ER physician posted a query about the removal of patients from the LSB and wanted protocols and opinions about them. The practices and acceptance of these practices have changed greatly since 2007.
  5. by   MassED
    Quote from Esme12
    You do know that this thread is 6 years old. AN ER physician posted a query about the removal of patients from the LSB and wanted protocols and opinions about them. The practices and acceptance of these practices have changed greatly since 2007.
    Yep, I know it's old.
  6. by   Altra
    Removing a patient from a long backboard does not in any way constitute "clearing" a spine and so there is no reason for nurses to not be trained to do so safely. Nor does care/treatment of a documented T/L/S spinal injury involve extended use of a long backboard.
  7. by   thelema13
    I do a trauma assessment, and as long as they have a c-collar, no reason for them to stay on a backboard unless there is a hip/pelvic pain or spinal pain.

    I grab a doc when they roll in the door or shortly thereafter- staying on a backboard is ridiculously uncomfortable. We usually clear them off the board pretty fast unless suspicion of a fx.

    If you take TNCC, they will teach a full head-to-toe trauma assessment and how to properly clear and remove someone from a backboard.
  8. by   ZippyGBR
    Quote from Altra
    Removing a patient from a long backboard does not in any way constitute "clearing" a spine and so there is no reason for nurses to not be trained to do so safely. Nor does care/treatment of a documented T/L/S spinal injury involve extended use of a long backboard.
    this was the key issues that people struggled with when the thread was new they couldn't seperate the position which I advocate which seperates removing the patient from the Long Extrication Board from clinical clearance of the spine, as that might be Step too far for the US posters even though Nurses and (health professional) Paramedics in the UK practice selective immobilisation and use the Canadian C spine rule or the very similar selective immobilisation decision tool in JRCALC . As a further to that we have an inpatient falls assessment document recently introduced which now suggests that All Nurses working for the trust I work in should be aware of selective immobilisation and how to fit a collar ... and guess who is suggested as the best resource and givers of advice on this topic ... not me personally, but me and my colleagues as part of the team on the Spinal unit ... (we've even been known to go and properly fit Aspen collars for the ED staff before.. )
  9. by   KellyBrackett
    Hey all -

    After a good bit of research, and a few meetings, we passed this protocol. The RNs are getting "on board" fast with it (pun intended), and we're working with EMS to make sure these interfaces go smoothly. There was remarkably little trouble passing this through the multiple committees.

    If anyone has any questions about passing something similar at their shop, email me at brooks.walshatGmail.com.
    **************************************
    Title:
    Emergency Department(ED) Long-Spine Board Removal Policy Background


    Policy:
    While maintaining spinal precautions according to standard practice, ED RN staff will remove patients from the LSB, with the assistance of the transporting EMS crew or available emergency department staff.


    Purpose:
    Cervical spine immobilization, through the use of cervical immobilization collars (CIC) and spinal precautions (SP), is felt to be protective when a patient has a known or
    suspected cervical spinal fracture, and is common practice in the ED. The use of the long-spine board (LSB), however, has been associated with numerous potential adverse effects. Adverse effects of the use of the LSB include tissue ischemia, and the heightened risk of pressure ulcers. Furthermore, an unattended patient who is fully and properly restrained on a LSB is unable to turn him or herself if they vomit. A number of experts in emergency trauma care recommend the removal of a LSB as early as practicable after arrival in the ED.

    Procedure:
    The patient, while immobilized, will be moved to a stretcher. The head-blocks and tape will be removed prior to removing the straps across the torso and legs. Logroll according to standard spine precautions will be performed, and the LSB
    removed. The patient will be left in supine position, with the CIC left in place.
    The minimum team for LSB removal will comprise of 3 healthcare providers. ED RN will
    remove the patient from the LSB with the assistance of the transporting EMS crew or available ED staff. It should be emphasized that this policy does not describe or endorse RN “clearance” of the cervical, thoracic, or lumbar spine. During removal of the LSB, spinal precautions will be maintained.

    Exclusion:
    This policy does not apply to:
    * Patients triaged to Trauma Alert or Trauma Code status, or
    * Patients placed on a LSB without a CIC or SP, in order to facilitate extrication and
    transport (e.g. atraumatic artificial hip dislocation).

    Inclusion
    Patients are otherwise universally eligible for removal of LSB, including patients:
    * Of all ages,
    * Of any level of mental status, or
    * With any source or degree of pain (including neck or back pain)

    References:
    Early acute management in adults with spinal cord injury, J Spinal Cord Med. 2008; 31(4)408-479

    Vickery D, Emerg, Med J 2001; 18; 51-54 The use of backboards after pre-hospital phase of trauma management

    Kwan I, Cochrane database of systemic reviews 2001, Issues 2

    March JA, Prehosp Emerg Care. 2002 Oct-Dec; 6 (4):421-4 Changes in physical examination caused by use of spinal immobilization

    Totten 1999 Respiratory effects of spinal immobilizations www.ncbi.nlm.nih.gov/pubmed/10534038

    Berg GM, J Trauma acute care surg 2012 Mar; 72(3):793-5 Pressure ulcers in the trauma population

    Lubertt, Eur J Trauma 2005; 31:375-8 Is there reason for Spine Board immobilization in the emergency department
  10. by   ZippyGBR
    hi Kelly

    glad to hear you have had success with a sensible policy , i presume your exclusion of 'trauma code' patients is because of the way in which that will work with respect to ATLS type methodology and puts the decision if and when with the trauma team leader doctor ...l
  11. by   KellyBrackett
    Ironically, the more seriously injured patients spend the least amount of time on the board. They all come off, right at the start.

    Collar usually stays on, though, at least initially

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