Vitals and Neuro Assessments

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    I work in a NeuroScience Critical Care Unit where we have 12 ICU and 10 Intermediate beds (Neurology/Neurosurgery/Trauma). During patient care council today we spent an hour calling other hospitals trying to bench mark on vital signs and assessments.

    Please give feedback what are your routine or standard of care?
    Vitals and neuro assessment for ICU? :heartbeat
    Vitals and neuro assessment for Intermediate? esp. 1st 24 hr upon arrival?!:heartbeat

    Thank you ahead of time for your help!!
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  3. 3 Comments so far...

  4. 0
    It really depends on what kind of surgery/trauma that your talking about. Also, are you talking about ICP measurements. Also, are you treating CVA pts? What is your Pt/nurse ratio? It really depends on what you are treating. Every neurosurgeon I have worked with had their own set of orders for specific surgeries. Lamis were Q15 x4 then q 30 x2, then q1hrx2 and so on. Cervials had a different set, anterior cervial another. Then cranis had had different.
    If it was a trauma then it was something else. I'd speak with your neurosurg. and see what they expect and/or want.
    Hope this helps.
  5. 0
    I have worked in two different neuro ICU's. Both 24 bed units in level 1 trauma centers taking all types of neuro pts...trauma, stroke, sc's etc. The standard seems to be hourly vitals for everything. Charting by exception seems to be the norm. The only reason you need to chart more would be an abnormality and what is being done to correct it and the results of the treatment. I personally am an advocate of charting what needs to be charted not just some nonsense q 15 min. for the first two hours for the sake of "proving" you are watching your patient. New admits have a lot going on and the focus needs to be on the patient and not the paper work. That being said...if its post surgical and you are recovering your own patients and bypassing the PACU then I would ask the norm for the PACU I know vitals there are much more frequent but I may be incorrect but I believe it has a lot to do with the fact a lot of PACU patients are extubated there and welll ABC's!!!. I agree also it should be clarified with the physician. Also maybe check with the AANN.
  6. 0
    ps intermediate beds tend to be q2 but being acute back ground I would want to do q 1 for the first 24 provided the nurse patient ratio is no more than 3 to 1 and concern with assignments should be heeded. I wouldn't want to give a nurse 3 pts with q 1 hour vitals. Besides, I sometimes think taking care of a waking neuro patient may be the toughest job around....haldol, ativan, restraints and lots of well stinky stuff


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