Quote from gwenith
The Glasgow Coma Scale has been used successfully for a number of years now BUT it has it's limitations. I find it especially limited with the non-verbal or ventilated patient. It is frustrating because you are getting appropriate responses that indicate the patient is fully orientated but cannot indicate that within the chart as it currently stands.
Is anyone using a modified scale for non-verbal patients?
Is anyone using the Adelaide children's Scale?
Does anyone have any other "gripes" or problems with the GCS??
Yeah, I understand those concerns, but that's what makes someone who is oriented x3, on a ventilator and following commands an "11T". The "T" being specifically for patient's who are on a ventilator and therefore cannot have their speech assessed. I thought this was a standard?? I didn't think the one we used was a "modified" one.
Just in case, our scale runs like this:
: 4 = spontaneous, 3 = to voice, 2 = to pain, 1 = no response 1UTA = Unable to assess (for times when someone is sedated, like with propofol).
: 5 = oriented, 4 = confused, 3 = incomprehensible sounds, 2 = moaning (forgive me if I put 3 & 2 in wrong order, I just woke up), 1 = no response, 1T = Patient is intubated or trached, 1UTA = Unable to assess (again for sedation reasons).
: 6 = follows commands, 5 = localizes, 4 = withdraws, 3 = decorticates, 2 = decerebrates, 1 = no response, 1UTA = Unable to assess.
We don't use the Adelaide scale because we don't take children in our ICU. Our patient's are at least 13...which even that young is rare for us because a lot of them will go to our Pediatric ICU which has open visitation and is more suited for children.
As for them being oriented, but on a ventilator, I handle it this way. (First let me say that we use a computer system called "Emtek" to chart and each assessment, there is 5 screens. Three of them are 1. VS screen, 2. Neuro screen, 3. Assessment screen.) On the VS screen, I chart the accurate GCS score from above. In the neuro screen, under LOC, I'll chart: "Patient is awake, alert and oriented to self, place and time. Patient follows commands with all extremities." Then there is a space below that to actually chart about speech, which I'll chart: "UTA patient's speech. Patient is orally intubated. Patient nods head for yes/no questions and is mouthing words to communicate." (or whatever the case may be). Then, I also note this is in the assessment screen (which is where the BIG note, for all body systems, goes).
Glascow is only a small tool in the big picture. We've never really had a problem where it doesn't fit our needs...only because we usually explain ours more than "Mr X is an 11T". Our docs want to know specifically what the pt. is doing.
Hope this helps Gwenith!!!! Goodness knows you've helped many of us soooo much!!