Frequency of neuro checks in Neuro ICU

[Soleil72]

Just wondering how frequently nurses do neuro checks in the neuro ICU. We do hourly neuro checks for weeks. To me it seems excessive when patient's have not had a neuro change in days. Often when we ask the Attending if we can change to q2 we get shot down. I understand patients with SAH with vasospasm risks need to be monitored more closely but strokes, SDH, tumor resections? Of course patients who received TPA we do the standard q15, q30, q 1... I have worked at other facilities where neuro checks were done q1 X12 then q2 then changed to q4 when appropriate. Thanks in advance, Diane

[Here.I.Stand, BSN, RN]

We do the q15/30/60 min post-tPA. We do them q 1 hr for unstable bleeds or if there's other specific cause for concern, but most of our pts are q 2 hrs. If they have an EVD or a Camino we check an ICP q 1 hr at least, but don't necessarily wake them up for a neuro check.

Q 1 hr neuro checks for weeks in relatively stable pts is a recipe for delirium.

[HouTx, BSN, MSN, EdD]

My guess? The frequency may be tied to admission/discharge criteria & they want to avoid the 'why is this person still in ICU?' issues that may arise if those q 1h checks are stopped... but then, I am a self-admitted cynic.