Nurses taking patient's off backboards without doctor clearnce?

[the big nurse]

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

[S.T.A.C.E.Y, LPN]

ok, so what do you do in your ER when you find out the pt has a fx...say t4 or L1 or whatever.......Do they permanently stay on the board? My understanding has always been that the board was for transport only.

[EricJRN, MSN, RN]

Keep in mind that it is now increasingly common for prehospital providers to "clear" (or more accurately, decide not to immobilize) many patients that would have been C-collared and boarded a few years ago. If EMS agencies can develop safe guidelines for this, I would imagine that some ER's have done the same with their nurses.

If it's not written in a protocol and there is not at least a verbal order, that's trickier.

[bigsyis]

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.

It is a risk I don't advise anyone taking, policy or not. When you are asked to defend yourself, a policy is better than nothing, but it does not take the place of good nursing judgement in checking w/the ERP and having his VO cover you.

[bigsyis]

ok, so what do you do in your ER when you find out the pt has a fx...say t4 or L1 or whatever.......Do they permanently stay on the board? My understanding has always been that the board was for transport only.

Again, whatever the ERP orders. If he says that the sorry mattresses on the ER stretchers are adequate to support the fx, then so be it, and chart that the board was removed after d/w Dr. Blahblah.

[RN1980]

ok, so what do you do in your ER when you find out the pt has a fx...say t4 or L1 or whatever.......Do they permanently stay on the board? My understanding has always been that the board was for transport only.

they'll stay on the board until hell freeze over or until er doc or neuro/ortho doc tells me to take'em off. litsen if a patient is brought in the er on spinal percautions by ems that right there has set the standard of care for that patient until the patient is medically cleared by a doc it is prudent that you keep that patient on the percautions and i tell you that you would be very liable if you took it upon yourself to remove the percautions "even if you did a through assessment of the patient" and turned out the pt had fx,strain or nerve damage that could've been aggrevated by you removing them from the board or d/c'ing the c-collar. hey if ems thinks it's a good idea to put the patient on a board to begin with i'm sure as heck not going to remove it until cleared by the doc, and i'd advise you to do the same.

[Medic/Nurse, BSN, RN]

Tough one.

Like Craig, EMS in different locales boards "everybody" and it is generally safe to take 'em off the board. Others note that EMS "clears" the CS in the field and the patient is never "boarded".

Even with a "policy" my position is succinct. NO.

Expanded -

The "cost" of being wrong (about the CS) is high.

The "cost" of being right (about the CS) is marginal at best.

If you are WRONG and the patient has an undetected CS or any spinal fracture compromise you will be in trouble beyond your wildest dreams. (The deep dark doo doo kind)

If you are RIGHT and the patient got lucky and it rubs off on you - well, you are saving the patient from a "time" of discomfort.

Lets say the patient has a compromising injury - they may spend a lifeTIME in a wheelchair (or worse) if their spine is improperly "protected". Kinda makes the decision a bit easier.

FYI-We do not fly suspected trauma patients without full spinal restriction. Exception - isolated extremity injury without mechanism. Everyone else (even inter-facility that may have been "cleared" by the referring facility) is transported in full spinal immobilization. PITA, yes at times. Saves my a$$ and the patient, yes at times.

Practice carefully.

Practice SAFE!

[suzanne4, RN]

Simple rule to follow is what your policy states for your unit and what is says in writing. Not that everyone else does it. If it is not listed there as a procedure for nurses to be undertaking, then you should not even consider it. And more than likely, you are not going to find it in the policy and procedure book of any facility.

If you remove a backboard and injuries show up, then it is your license that will be on the line with the attorneys.

Just not worth it.

And as the above poster stated: Practice safe.

[scattycarrot, BSN, RN]

This is an interesting thread. The ER that I worked in when I was in the UK allowed us nurses to remove patients from spinal boards routinely. We usually did it as soon as they came in, with the paramedics present so we could log roll and maintain spinal alignement. The collar would be left in situ, board would be removed, the patient rolled back and the patient would be strapped down. All of this would be documentated and would only be done on patients with a GCS of 15, no obvious injury or neurological deficit and a good history of mechansim. The spine would not be cleared and full spinal precautoins would be in place, just the hard board would be removed. From personal experience, those boards are hard to tolerate for more than 1 hr and we can tell patients that some discomfort now is better then a lifetime in a wheelechair but if you have never laid on one, than try it! As a unit, we noticed better compliance when the boards are removed. We also had NP's who were trained in the Canadian C-spine rules and would remove collars and clear spines. But, this was all unit policy and I agree with the other posters who say unless it is written policy than don't do it. Thats especailly true in the States due to the alarming rate of litigation!

[nuangel1, BSN, RN]

in my ed only the drs clear the pt form board and collar .its in the drs scope of practice not mine as a nurse.

[ZippyGBR, BSN, RN]

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

assuming the restrictive and prescriptive way in which the US works in generla doesn't get in the way ( thank chosen deity for the attitude in the UK where it;s the training , education and competencies that decide on what peopel do rather than what their name badge says...) - why not assuming the patient meets accepted and documented criteria for not being immobilised

the physical examination skills required to decide that someone does not need immobilisation are those which any decent ED RN should already have - because you should be using them in triage to differentiate whipcash, from whiplash from a potnetial bony spinal injury... canadian C-spine rules seem ot be a common basis for decision algorithms in the Uk including a pre-hospital one ( in the JRCALC national ambulance guidelines) that can be used by Qualified Ambulance Technicians as well as Registered Paramedica

[ZippyGBR, BSN, RN]

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.

as a TNCC provider ( and a PHTLS provider FWIW) that's not quite the truth is it...

a collar alone does not provide C spine immobilisation

a collar and manual immobilsation

OR

a collar and properly 'fitted' head blocks/ sandbags and tape

does

the board is irrelevant in the ED

[ZippyGBR, BSN, RN]

they'll stay on the board until hell freeze over or until er doc or neuro/ortho doc tells me to take'em off.

at which point you've broguht them a potentially fatal condition or at the very least a much prolonged stay in hospital which we heal and/or surgically repeair th iatrogenic pressure ulcers

litsen if a patient is brought in the er on spinal percautions by ems that right there has set the standard of care for that patient until the patient is medically cleared by a doc it is prudent that you keep that patient on the percautions and i tell you that you would be very liable if you took it upon yourself to remove the percautions "even if you did a through assessment of the patient" and turned out the pt had fx,strain or nerve damage that could've been aggrevated by you removing them from the board or d/c'ing the c-collar.

why bother going to univerisity for 4 years if all you do is wait for orders from the big clever doctors...

hey if ems thinks it's a good idea to put the patient on a board to begin with i'm sure as heck not going to remove it until cleared by the doc, and i'd advise you to do the same.

given that the US lets people with 110 hours of cookbook protocol following training ride on emergency ambulances ... we have better trained first aiders in rightpondia than that...

if you were an inexperienced Dutch RN then maybe ( dutch paramedics are all Nurse Practitioners)