neuro checks on A&O patients at night

Specialties MICU

Published

What do you think of the need for sleep in a stable patient? Does your neuro surge team/resident on call come and fully awaken an A&O stable patient in the middle of the night to do a neuro check (i.e. lights fully on, fully awakening the patient and talking to him/her as though it were 2 pm, not 3 am, asking them how they are doing, ect). What is the norm at your facility?

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Specializes in ICU.

First off, there is no neuro team on call and there are no residents of any kind. We have two neurologists, but they round during the daytime, and they only round on neuro patients anyway. I am really not sure what you are talking about with the neuro team rounding on A&O patients - why is neuro consulted if the patient is not neurologically impaired?

As far as me personally? Most of the time I let them sleep if they are that healthy. My "q4h" assessments happen whenever the patient wakes up - if I have to wake them up to give a medicine, when lab comes in around 4 to draw them, whenever they wake up to go to the bathroom... I absolutely do not wake up fully alert and oriented patients in the middle of the night unless I have a compelling reason to do so. Now, if the patient is really sick... that's different, but we have increasingly been babysitting floor patients in my ICU. I had someone so stable last night that the physician had DC'ed telemetry orders but left the patient in ICU... if we are not even supposed to be monitoring the patient per the physician, and the patient has no business in ICU, I am not going to treat him/her like an unstable ICU patient and wake him/her up every four hours on the dot for a full head to toe assessment.

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Specializes in Trauma Surgical ICU.

Im not really sure what you are asking so I will answer for my facility. No neuro teams, the neurosurgeons make rounds during the day unless it is an emergent situation then they are at the bedside for what ever needs to be done, no matter the time. We update them on our assessments re pupils, muscle strengths, speech, etc. If the pt is ordered q1h neuro assessment, then yes WE the nurses wake the pts every hour for those checks. If neuro checks are ordered that frequently is it needed,even on an AAO pt. This pt has the potential to go bad fast. This type of pt usually has a some type of bleed and the surgeon is worried it will get bigger/worse. I do tell the pts and their families what to expect all night and that it is very important they answer all questions,and why because some like to be stubborn or joke with us.. Stat CT is not fun when the pt is BS'ing us.. For pts that are not neuro ie strokes/bleeds neuro assessment are q4. Hope this helps

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If the pt has orders for q1 or q2 hour neuro checks or if the pt is a neuro pt with q4 hr neuro checks, then yes I wake them. However, most of my patients are not neuro pts and if they are hanging around in the ICU waiting for a bed on the floor and are completely a&o, then no I do not wake them to do an assessment. I will wait until the either get up, or if I need to give meds or turn. If the pt is on propofol or is unstable and on gtts then yes I wake them up q4 hrs or as needed.

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Specializes in SICU, trauma, neuro.

Neuro pts on my unit are generally ordered to have q1hr or q2hr neuro checks anyway, so they're getting roused a lot. I'll know when to expect the neurosurg resident to round b/c s/he will call or approach me and ask me to turn the sedation off. I then follow the dr. into the room for their exam, watch to see the findings myself, and then chart them for the next due exam. It usually works out that it happens when I have one coming due; if the dr. just did a full exam at 0145, I'm not going to wake the pt again at 0200 myself and do a new exam. Of course that doesn't work if the dr. calls at 0205 and I've already gotten my own for 0200.

I do cluster cares as best I can. I do realize that sleep is important, and I'm sure they hate being woken q1hr. This way it's not MORE frequently--neuro exam at 0200, med at 0230, etc.

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Specializes in ICU.

If neuro checks are ordered, we do them, regardless whether we have to wake them up or not. Neuro checks are usually ordered for every 2 hours at my hospital. If we fail to do them right, we get a note from administration about it. If you don't think they are necessary, get the doctor to discontinue them.

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Or ask to have the dr order " quiet hours" from this time to this time to let the pt sleep without having to do neuro checks. if the dr says no to this because they feel they need them, then wake them up and do neuro checks.

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Specializes in critical care, ER,ICU, CVSURG, CCU.

the problem with neuro check patients is, things can deterioate when they appear just to be asleep....

thus i usually do brief, assessment even when asleep.....real headache to have an asleep patient being obtunded from neuro deficit

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Specializes in Critical Care.

If they're alert and oriented, and have neuros q1, there's a good reason, and they're getting them. How would you like to be the one to find a neuro change at 430/500, and the last time you assessed them was around midnight? That would be a really fun conversation with the doc, and may end up putting your license at risk.

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Specializes in Critical care.

It depends on what is wrong with the patient. If they're a neuro patient and it's been asked they have neuro obs done at a certain frequency then as others have said here, there's good reason for this. I'd wake the patient and check them rather than have someone appear to be asleep when they've actually deteriorated, it's better to have a ratty tired patient than one who has a significant brain injury that could have been prevented.

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