Nurses taking patient's off backboards without doctor clearnce?

Specialties Emergency

Published

The place I am currently working takes their patients off the back bard before the doctors clear the pt. Dose anyone know or heard of this practice anywhere and what studies have done to backed this practice up.

thanks

Specializes in Spinal Cord injuries, Emergency+EMS.

a number of issues here

1. removing the long EXTRICATION board at triage does not imply that the neck is 'clear', stable or anything else, it's about removing a harmful and not required restraint ...

if it isn't required in other IN_HOSPITAL settings for a patient with a confirmed unstable spine, why is in required in the ED.

2. there are clinically verified, evidence based clinical clearance / selective immobilisation guidelines. use of the selective immobilisation guidelines is within my scope of practice. However this is irrelevant with regard to the 'therapeutic' removal of the Long EXTRICATION Board at the first appropriate time on arrival in the emergency department

3. A Long EXTRICATION Board provides NO C -spine immobilisation on it;s own and in certain patient groups can prevent effective immobilisation ( e.g. Paeds due to the relatively larger head of the pre-pubescent , or the eldery due to age related kyphotic changes) - effective C spine immobilisation is provided by manual support +/- a collar or collar, tapes and blocks / sandbags.

4. A Long EXTRICATION Board does not provide effective support or immobilisation of the T-Spine or the L-Spine and poses a positiver hazard to skin integrity over the sacrum

5. a patient immobilised on a A Long EXTRICATION Board is a hazards to themselves and /or others if left immobilised and it is possible that they will roll off the trolley when attempting to pressure relieve.

6. a A Long EXTRICATION Board and restraints when used without appropriate clinical justification may count as Battery, or illegal use of restraints ( in those places who still consider it acceptable to tie people to the bed for the convenience of staff)

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Specializes in Spinal Cord injuries, Emergency+EMS.
Zippy, there really is no point. You are not understanding, and it seems you never will. Good luck in your nursing practice. I hope we shall never meet.

what am i not understanding MassED ?

I understand that you seem unable to accept the views of others even when they are backed by sound clinical reasoning and national clinical practice guidelines

I understand that you seem unable to critically evaluate your own and other's practice instead relying on ' that's how we've always done it ' or 'it's illegal , but I don't know what the law that actually makes it illegal is ... )

I understand you do not seem able to verbalise what is so magic about a physician's hands

I understand that you do not comprehend the principle of the 'level of skill of the ordinary man professing to hold that skill '

if you were a student ( pre or post registration, it's immaterial) why shouldn't i refer you because i'd be very suprised to see an assessment document that allowed the assessor to pass someone who is unable to support their assertions

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Specializes in ER.
what am i not understanding MassED ?

I understand that you seem unable to accept the views of others even when they are backed by sound clinical reasoning and national clinical practice guidelines

I understand that you seem unable to critically evaluate your own and other's practice instead relying on ' that's how we've always done it ' or 'it's illegal , but I don't know what the law that actually makes it illegal is ... )

I understand you do not seem able to verbalise what is so magic about a physician's hands

I understand that you do not comprehend the principle of the 'level of skill of the ordinary man professing to hold that skill '

if you were a student ( pre or post registration, it's immaterial) why shouldn't i refer you because i'd be very suprised to see an assessment document that allowed the assessor to pass someone who is unable to support their assertions

if you can't understand the legality of those actions, then there is no point restating what has already been stated. If all nurses could remove a patient from a board, then why do we need any docs? Why not just intubate that patient when we feel it's needed? Just because we critically assess the patient to need or not need many things, we can ANTICIPATE the order, but cannot act as the doc. Am I clear on this? Anyone else see the logic in this? You cannot act as the physician. Are you a nurse? How can you justify, on your nursing license, acting outside of your scope of practice? I suppose if you practice outside of the U.S., then you might have a different scope of nursing practice....

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Specializes in Emergency/trauma.

Maybe it's because i'm in canada that we do things differently, but in my hospital, which is a level one trauma center, we leave the patient the least amount of time on the backboard to preserve the patient's skin integrity. As soon as the patient is back from his x-ray and CT, we (the nurses) take it as our responsibility to remove the backboard. As long as we mobilze the patient according to protocole (in block), that we leave the collar on and keep the patient in a flat supine position, the spine will stay intact. If we wait after the doctor to re-assess the patient it will take forever. And certain people like elderly patients, intoxicated patients, or patients with previous back problems aren't able to tolerate the backboard for a very long time. That's our practice and it works. And yes we do document the time that the backboard was taken off.

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Specializes in ER.
Maybe it's because i'm in canada that we do things differently, but in my hospital, which is a level one trauma center, we leave the patient the least amount of time on the backboard to preserve the patient's skin integrity. As soon as the patient is back from his x-ray and CT, we (the nurses) take it as our responsibility to remove the backboard. As long as we mobilze the patient according to protocole (in block), that we leave the collar on and keep the patient in a flat supine position, the spine will stay intact. If we wait after the doctor to re-assess the patient it will take forever. And certain people like elderly patients, intoxicated patients, or patients with previous back problems aren't able to tolerate the backboard for a very long time. That's our practice and it works. And yes we do document the time that the backboard was taken off.

we don't send pt's to xray on a backboard. A patient is seen by the MD - at least to get off the board, then it's documented that MD such and such assessed, removed pt from board - then pt will be sent for studies. Never would send a patient on a board unless it was specifically stated by the ordering MD.

I would imagine there are many different standards of nursing when you are working within a different country. I can only speak for my experience and where I've worked, in the U.S.

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Specializes in Spinal Cord injuries, Emergency+EMS.
if you can't understand the legality of those actions,

if it;s illegal then you should be able to defend your position, the easiest way to defend a statement is to prove by reference to the legislation that it is illegal ... proof by assertion is invalid

then there is no point restating what has already been stated. If all nurses could remove a patient from a board, then why do we need any docs?

removal DOES NOT equal clinical clearance.

removal , but continuation of the appropriate immobilisation recognises two principal factors

1. Iatrogenic harm will be caused by prolonged immobilisation in/ on and extrication device , it is also a battery if there is no necessity for it

2. there is no valid kinematic reason to maintain the suboptimal immobilisation provided by a Long Extrication Board in the non- moving environment of the emergency department vs in the back of an ambulance travelling at 50 -130 kph or in the back of a helicopter flying at 160 - 260 kph

there is a substantial evidence base for the selective immobilisation and clinical clearance decision support tools, which are used by Nurses and health Professional Paramedics across the world as well as by Medical Practitioners.

is there something magical about a physician's hands to enable them to perform the physical examination required by these decision support tools over the hands of the RN or Health Professional Paramedic?

Why not just intubate that patient when we feel it's needed?

if you are competent and the patient requires it , not doing so is negligent , if it is the decision that would be made by the ordinary man professing to hold that special skill. are you an autonomous professional or a hand- maid?

Just because we critically assess the patient to need or not need many things, we can ANTICIPATE the order, but cannot act as the doc.

if you are competent and the patient requires it , not doing so is negligent , if it is the decision that would be made by the ordinary man professing to hold that special skill. are you an autonomous professional or a hand- maid?

an order or lack thereof is not a defence against a clinical performance incident.

Am I clear on this? Anyone else see the logic in this? You cannot act as the physician. Are you a nurse?

yes i am

How can you justify, on your nursing license, acting outside of your scope of practice?

If you are competent and the patient requires it, not doing so is negligent, if it is the decision that would be made by the ordinary man professing to hold that special skill. There are situations where the law or organisational policy requires you to contact or involve others , but 'just following ( or waiting ) for orders' will not necessarily be an adequate defence in the case of an adverse outcome , neither will not raising concerns or problems with management, it may go someway to provide mitigation but opens further avenues to question your professional practice.

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Specializes in Trauma/ED, SANE/FNE, LNC.
Maybe it's because i'm in canada that we do things differently, but in my hospital, which is a level one trauma center, we leave the patient the least amount of time on the backboard to preserve the patient's skin integrity. As soon as the patient is back from his x-ray and CT, we (the nurses) take it as our responsibility to remove the backboard. As long as we mobilze the patient according to protocole (in block), that we leave the collar on and keep the patient in a flat supine position, the spine will stay intact. If we wait after the doctor to re-assess the patient it will take forever. And certain people like elderly patients, intoxicated patients, or patients with previous back problems aren't able to tolerate the backboard for a very long time. That's our practice and it works. And yes we do document the time that the backboard was taken off.

I can see our trauma centers in the US leaning more in this direction as well. Our most recent trauma conference focused on rapid removal from the backboard, (within 15 minutes of arrival) and encouraged those of us in trauma centers to establish protocol pertaining to this. Personally, I dont see anything wrong with removing the patient from the board, providing the pt is kept supine and in a c collar.

I think it will eventually become a nursing judgement call, and will certainly make those immobilized patients happier!! In the grand scheme of things, if my patient has a cervical fracture, the back board wont make a difference in the patients prognosis, once they reach the trauma center.

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Specializes in ER.
if it;s illegal then you should be able to defend your position, the easiest way to defend a statement is to prove by reference to the legislation that it is illegal ... proof by assertion is invalid

removal DOES NOT equal clinical clearance.

removal , but continuation of the appropriate immobilisation recognises two principal factors

1. Iatrogenic harm will be caused by prolonged immobilisation in/ on and extrication device , it is also a battery if there is no necessity for it

2. there is no valid kinematic reason to maintain the suboptimal immobilisation provided by a Long Extrication Board in the non- moving environment of the emergency department vs in the back of an ambulance travelling at 50 -130 kph or in the back of a helicopter flying at 160 - 260 kph

there is a substantial evidence base for the selective immobilisation and clinical clearance decision support tools, which are used by Nurses and health Professional Paramedics across the world as well as by Medical Practitioners.

is there something magical about a physician's hands to enable them to perform the physical examination required by these decision support tools over the hands of the RN or Health Professional Paramedic?

if you are competent and the patient requires it , not doing so is negligent , if it is the decision that would be made by the ordinary man professing to hold that special skill. are you an autonomous professional or a hand- maid?

if you are competent and the patient requires it , not doing so is negligent , if it is the decision that would be made by the ordinary man professing to hold that special skill. are you an autonomous professional or a hand- maid?

an order or lack thereof is not a defence against a clinical performance incident.

yes i am

If you are competent and the patient requires it, not doing so is negligent, if it is the decision that would be made by the ordinary man professing to hold that special skill. There are situations where the law or organisational policy requires you to contact or involve others , but 'just following ( or waiting ) for orders' will not necessarily be an adequate defence in the case of an adverse outcome , neither will not raising concerns or problems with management, it may go someway to provide mitigation but opens further avenues to question your professional practice.

I give up. :banghead:

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Specializes in Emergency/trauma.
("we don't send pt's to xray on a backboard. A patient is seen by the MD - at least to get off the board, then it's documented that MD such and such assessed, removed pt from board - then pt will be sent for studies. Never would send a patient on a board unless it was specifically stated by the ordering MD.")

Basically the board is used to transfer a patient who's in c-spine precaution, example: from the stretcher to the x-ray or CT table. If the patient is not on a board, the x-ray technician will refuse to do the exam. Sliding the patient with a board from point A to B allows us to keep the patient's spine intact during mobilization. When the exams are done, we have no reason to mobilize him further more. That's when we take the board out.

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Specializes in Spinal Cord injuries, Emergency+EMS.
("we don't send pt's to xray on a backboard. A patient is seen by the MD - at least to get off the board, then it's documented that MD such and such assessed, removed pt from board - then pt will be sent for studies. Never would send a patient on a board unless it was specifically stated by the ordering MD.")

Basically the board is used to transfer a patient who's in c-spine precaution, example: from the stretcher to the x-ray or CT table. If the patient is not on a board, the x-ray technician will refuse to do the exam. Sliding the patient with a board from point A to B allows us to keep the patient's spine intact during mobilization. When the exams are done, we have no reason to mobilize him further more. That's when we take the board out.

?Scoop Hoist ?

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Specializes in ER.

?Scoop Hoist ?

Don't got one. What is it? Do you have a link?

Also, we only have 2 people available in Xray to transfer from stretcher to table. (top and bottom) If we used the slide board (we have it) we'd take 4-5 people which would empty the ED of nursing staff during the night, and sometimes during the evening. Not safe for other patients.

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Specializes in ER.

?Scoop Hoist ?

that's not all my quote, only the top portion.

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