We have a policy where anyone on coumadin or blood thinners who hit their head be sent to er for ct, unless family refuses. Otherwise any fall with head injury notify physician and monitor for any change in condition. We monitor neuros every 15 mins x 1 hour, then every 30 mins x 1 hour, then hourly x 4 hrs, then every shift for a total of 72 hrs. That was the same policy at another facility I worked at.
VS immediately with grips,speech,pupils,mentation. Repeat q 15 minx1hr,q30minx2hrs,q4hrsx24hrs,q shiftx72hrs. restart sequence c each fall(even when multiple falls occur within this time frame. Labor intensive c frequent faller(65< y/o c prog.MS,avg.2 falls p/day. Impulsive,refuses intervention,head CT done-no TMT per pt./family/MD. And yes,this is a LTC c 57 others.
This is a personal policy of DON.
we have a release form if there is no apparent injury, the family can say no to ER trip. Many do refuse without known poss. head injury.
But yes, very many transfers. Wish I was in private ambulance business.
My Mom just underwent surgery today for a partial hip replacement. She had an unwitnessed fall on Monday afternoon and we were told that she would have xrays that night. Never happened until the afternoon of the next day. She has Alzheimers and I hope the accident and the surgery doesn't hasten her death.
You might think it's extreme and causes lots of unnecessary transfers but I am more than a little mad over the fact they waited until the next day to obtain xrays when they could have sent her to the ER that night and had them done there.
Wouldn't send them out immediately unless there was a clear head injury, a change in GCS, were on anti-coags or the family insisted. I think nurses are quite capable of clinical judgement without passing the buck unless its the policy of the facility. Or if the resident is alert and oriented enough to tell you they banged their head - but even then regular neuro obs will alert you to any potential problems. We've had aged folk come in from LTC's for an unwitnessed fall and are really cranky because all they did was slide off the edge of the bed!