Head injury routine

[Atala]

Hi fellow nurses, we are reviewing our post falls assessment policy and are wondering what the practices in other long term care homes are. Could you share head injury monitoring process in your organization- when do you initiate it, what’s the frequency, what’s included? Thank you for sharing!

[downsouthlaff, LPN]

Hi, Atala

Im a long term care nurse of five years. Falls are a big part of LTC. Some will argue that when a resident bumps there head they should always go out for a CT. At some facilities this is protocol, and also of course depends on there primary MD. In my opinion, and my facility policy, after the resident bumps there head and is assessed by a nurse, the nurse then notes any injuries and contacts the primary MD. If there is head involvement and a raised area is noted to head, it just depends on certain circumstances what actions are taken. Normally if the MD trusts the nurse’s findings and the resident has a raised area, but they never lost consciousness or don’t have any kind of alteration in mental status or S/S of a skull fx or concussion symptoms, close 72 hr observation, with neuro v/s and focused charting in my opionion are enough to suffice. As long as the MD doesn’t order or feel the need for an ED eval. I have always been an advocate of by passing the ED when able and using in house measures when it’s beneficial to the patient to do so. Now of course when any life threatening or dangerous situation arises for the resident definently pro ED transfer all the way.

[dream'n, BSN, RN]

Not in LTC, but in the hospital if the patient is stable and the Dr doesn't want a CT (which they usually do), we do neuro checks and VS q 15 minutes x 1 hour, then every 30 minutes x 1 hour, then hourly x 4, then q 4 hours x 2, then q shift for 72 hours.

[caliotter3]

In LTC we followed the protocol that dream’n posted. We had preprinted neuro assessment sheets.