Neuro assessment @ change of shift

[poppy07]

Recently, we've had quite a few neuro patients in our med/surg ICU, and I was asked by the neurosurgeons, "don't you guys do your assessments together at change of shift?" I wish I would have when the report I got sucked, and I was the only one to pick up on drastic neuro issues (pt herniated uncus).

What suggestions do you have, and how do you establish consistency in the assessments? For example, I noticed previous flowsheets stated abnormal flexion documented, but pt was clearly decerbrate posturing...

THANKS!

[mommy2BCD]

We do end of shift assessments some of the time depending on the acuity of the pt and based on the nurse I get report from. Some nurses you can trust others I like to get a picture of what they are seeing especially when the pt waxes and wanes. I think the errors in documentation are truly educational opportunities. I am a new grad RN and know the difference between flexion (decorticate posturing) and abnormal extension (decerebrate). I forget what type of unit you said you worked in, but I would hope that nurses wouldn't make these mistakes in a Neuro ICU (sorry I forget which unit you are on). We do our charting via flow sheets on large clip boards and we have cheat sheets taped to the under side of them for different assessment scales (Ramsey, Brayden skin scale, etc). I think you need to mention this to your educator, this is a real problem especially with neuro pts. in which changes like these could mean serious consequences for the pt. Just my

Best of luck to you :)

[suanna]

Don't work general neuro but I take care of fresh post op carotid entarterectomy patients. We do a joint neuro check with each hand off/shift change. Subtle changes are hard to document so by doing joint assessment you avoid the uncomfortable silence to the question " how long has he had this deficit..."

[gasmaster]

All the neuro units I've worked in required a hands-on assessment done at bedside change of shift. Think about this: what I might score on a GCS someone else might score differently but we are assessing the same. Discrepancies like that can cause unnecessary extra work to figure out if there is really a neuro change or just different charting among nurses. Some nurses are lax and don't chart all they should either. On the other hand, pt's change so fast that you may find true changes during this assess.