Nurses taking patient's off backboards without doctor clearnce?

ukstudent · Dec 4, 2007

Find out what the written policy is for taking someone off the backboard. If something bad happens due to this and all you can say is that everyone else is doing it, it wont look good. Follow the policy.

littleRNthatcould · Dec 4, 2007

As a rule "NO", at least in my facility. Granted there are times when some of our rural EMS squads have been known to board and collar some patients who may not necessarily need it. Example :little old lady who slid out of recliner onto her bottom on a carpeted floor.

That being said, without the proper x-rays and clearance you can never be sure of what underlying injury may be present. Spinal injuries are generally the sort of thing that can't be "eyeballed" even by the most seasoned nurse. JMO.

Finally, I wouldn't want to be the one responsible for exacerbating an exisiting injury, would you???

And if it's your patient and someone takes them off the board or orders them off document, document, document!

Good luck to you:nurse:

RN1980 · Dec 4, 2007

you are setting yourself of for failure and big trouble if you remove a patient from anytype of spinal package without previous assessment and permission by a doc...this would be nothing but a slam dunk fro a trial lawyer..to all you young er nurses out there, do yourself a favor, don't remove a c-collar spineboard or traction splint without first getting the doc to look at it and getting a order. and be sure to chart and time when you got the order from who and when you removed the device.

bigsyis · Dec 4, 2007

I agree with littleRNthatcould and RN1980-you are setting yourself up for disastrous consequences if you remove someone from a backboard before they have been cleared by the MD. Whenever I did, I always charted "per Dr. So-and-So's V.O." We work too hard to get and maintain our licenses to just give them away!

Blee O'Myacin, BSN, RN · Dec 4, 2007

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

It is my understanding that "clearing a patient" would fall under diagnostic medicine and as a RN, it would be outside my scope of practice.

If I had a nickel for the amount of times I've had to give the "I am the nurse, the doctor has to see you before we get you off of that board" speech...

You should definately check your facility policy - which should be changed to reflect what is allowed within the scope of practice, BTW. It's your license, do all you can to protect it.

Blee

RNcDreams · Dec 4, 2007

I agree with above posts-- I had a doc recently say "You can take the backboard out" on a pt who was found on his floor, and had been there for an unknown length of time. I know for a fact the doc didn't palpate the spine because the man was incontinent of feces up to his lower back, and still strapped in...... but one cannot remove the backboard to clean between it and the patient until the doctor has cleared the spine.... so, I carefully removed it, wrote "Backboard removed per Dr. Blabla" and was very relieved when the xr's were clear.

DOCUMENT!!

CraigB-RN, MSN, RN · Dec 4, 2007

I agree with littleRNthatcould and RN1980-you are setting yourself up for disastrous consequences if you remove someone from a backboard before they have been cleared by the MD. Whenever I did, I always charted "per Dr. So-and-So's V.O." We work too hard to get and maintain our licenses to just give them away!

I have to disagree. There is plenty of information out there that shows the majority of patient placed on backboard don't need to be on them. If your taking them off the backboard, you need to have witten policies covering you. You ned to cover things like documentation, distracting injuries, ETOH and such. It can be safe, if your doing it right.

S.T.A.C.E.Y, LPN · Dec 4, 2007

Its routinely done at my hospital, unless they are a major trauma patient going direct to our trauma room. As wait-times are often hours and hours (yes, even if from EMS) it is routine that the nurses roll the patient off the backboard. Collar remains on, and pts are told that they are not to move. Sometimes the doctors will come over to check the spine as we do it, just to save time later on, but not always. It is required that all nurses are TNCC certified.

DavidNurseEMT · Dec 4, 2007

We don't do it at the hospital I work at because we can pull a resident pretty easily to atleast palpate the spine.

Honestly though,a backboard is used primarily to maintain spinal stabilization in the back of a bumpy ambulance.Think about it? Even when patient's do have spinal injuries (fractures etc.) you don't keep them on a backboard during their entire hospital stay. As long as you keep the cervical collar on and maintain good cervical stabilization then you should be all set.

mianders, RN · Dec 4, 2007

I worked in the ER for years and would never take a patient off a backboard without a doctor's order. You can not maintain spinal immobilization with just a c-collar. If you have TNCC you know that the head needs to be taped to the board to completely immobilize the c-spine. You can not trust the patient to hold there head in a neutral position. In fact our computerized charting asks which physician gave the order. It only takes one c-spine fx to make you lose your license.

RN1980 · Dec 4, 2007

again do yourself a big favor, don't take the patient off until the erp gives you an order, if the patient or family takes them off so be it, if your egotistic charge nurse tells you too, tell them no, you want the doc to check them out or just make up a lie but don't, or let them do it. and again to all the young new er nurses out there, do yourself a favor get clearence from ther doc...somehting simple as that will save you a headache.