Nurses taking patient's off backboards without doctor clearnce?

BULLYDAWGRN, RN · Dec 8, 2007

Actualy the large majority of lawsuits are from people staying from the protocols. I don't practice in fear, and taking someone off the backboard isn't "clearing" the C-Spine. Again go up to the neuro ICU/Trauma ICU and look at the patients with known back injuries. They aren't laying on a long board, and a large proportion don't have HALO either. I've taken care of patients or days, who don't have their C-pine cleared, because they weren't able to tell me if it hurt, all laying on a hosp bed with a c-collar, they were turned, washed, and all that nursing care stuff, all withouth a back board and all without having their c-spine cleared.
I've heard tons of anectdotal responses, but none based on fact. I've and open mind, if someone can point me to actual case law, I'll look at changing my practice.

hey you or anyone can nurse anyway they feel like they need to. and again i'm not making the issue out of "you can't take care of someone who is off the board, of course they have to get off the board eventually" hell even in this war zone we get them off boards but again the er doc is the one who decides when to remove the board, if he is unsure he'll consult neuro/ortho..that is the only point i'm trying to make...that to keep yourself from getting slammed by some slick law dog. again i'm sure everyone takin care of officially uncleared spines that the patient is off the board, hell i've done many myself, but i do not and will not take a patient off a board without the doc looking at them or getting an ordr first.. not in mississippi or here in iraq..

RN1980 · Dec 8, 2007

holy crap this thread is still going on this subject...yep people will nurse the way they want to, but one good litigation will defenitly change the way a person nurses..as my old drill sgt. always said "stay alert stay alive"..

ZippyGBR, BSN, RN · Dec 9, 2007

Actualy the large majority of lawsuits are from people staying from the protocols. I don't practice in fear, and taking someone off the backboard isn't "clearing" the C-Spine.

exactly , especially if the person remains in a collar and head restraint pending clinical or radiological clearnace.

Again go up to the neuro ICU/Trauma ICU and look at the patients with known back injuries. They aren't laying on a long board, and a large proportion don't have HALO either. I've taken care of patients or days, who don't have their C-pine cleared, because they weren't able to tell me if it hurt, all laying on a hosp bed with a c-collar, they were turned, washed, and all that nursing care stuff, all withouth a back board and all without having their c-spine cleared.

exactly

also for those who rely on radiological clearance consider the phenomena / syndrome / fact that is SCIWORA

I've heard tons of anectdotal responses, but none based on fact. I've and open mind, if someone can point me to actual case law, I'll look at changing my practice.

that's being generous i've heard a lot of dogma and protocol monkey orifice coverage and very little patient advocacy ...

"they stay on the board becasue EMS put them there" - disregarding that fact that for many in the US EMS providers may have as little training as 110 hours ( the USDOT EMT_B core curriculum) and even if cared for by paramedics, the paramedic is not an autonomous accountable health professional.

" you can't clear the spine without X rays / CT " odd then that elswhere i nthe civilised world C spines are routinely cleared by clinical means by a variety of practitioners including RNs and EMS providers

" only doctors can make 'diagnoses " - this is one of the biggest things that makes non USAn nurses laugh the constant and seemingly irrational fear of 'practising medicine without a licence ' - yet we are told how wonderfully autonmous and highly skilled RNs i nthe US are ...

mmutk, BSN, RN, EMT-I · Dec 9, 2007

Most nurses here are TNCC certified also, but that doesn't give us any special xray vision. So NO all patients on backboards are only cleared by the Doc. We turn a light on our tracking board to let the MD know if a patient is boarded.

As to the above post, I see no problem if you take a pt off the backboard after xrays are performed, but if you do it before xrays, you are liable for the patient suing you saying when you took them off the backboard you may have caused an injury to the neck.

CraigB-RN, MSN, RN · Dec 9, 2007

http://www.ohri.ca/emerg/nursing-cspine.html

http://www.aemj.org/cgi/content/full/14/5_Supplement_1/S48

Granted this was from a 30 sec Google search and not a detailed meta anysis.

I'm working on a more extensive search using a couple of legal databases for cases of law suits involving c-spine clearence. These take a litle longer as the search critera needs to be specific and such.,

I'll admit up front that some of my comfort level in removing patients from long boards (Notice I didn't say clear a c-spine) come from the fact that over the past 30 yeras I've practiced in some out of the box locations. Locations were I was the only provider and if I didn't take them of the back board they would have layed there for 7+ hours. I've been a trauma/Sicu nurse, a Flight Nurse, As well as a EMT-P instructor in an area that allowed paramedics the ability to choose NOT to imobilize patients and a trauma researcher. I participated in a stufy in the mid 90's that looked at medical records from Vietnam looking for cases of C-Spine injury.

I think in looking at this whole problem area, we need to look farther. Establish some common language. ie clearence vs removing long board imobilization. and base education and competencies. There is a lot of fear, due to some early education and thoughts that havn't stood up to the test of time. But there are a lot of areas in medicine that we took as dogma and found were wrong. That is the nature of medicine. In some cases the things that we thought were a given, turned out to be BAD for a patient.

Will I continue to take patient off back boards, (not clear c-spines) yes, I've got education, trainign and experience and a written policy that gives me guidlines. Will there be patients that I won't take off a back board, Yes. Will I shake my head at nurses who put c-collars on patients in triage, when the patient had their MVC 6 hours ago and have been walking around is turning their head, left and right in triage, Yes. Will I do it, Yes becasue our protocol says to.

The one thing I do in all those cases is to document my you know what off. I document the patient M&S when I get them from EMS, I document my assessents, and I document the assessment after I take them off the board.

ZippyGBR, BSN, RN · Dec 9, 2007

As to the above post, I see no problem if you take a pt off the backboard after xrays are performed, but if you do it before xrays, you are liable for the patient suing you saying when you took them off the backboard you may have caused an injury to the neck.

rationale?

given that even with gold standard extrication at scene there is far more movement of the patient at scene than there is doing a controlled move in the emergency department , - one which does not involve rolling if you use a scoop stretcher to remove the patient from the board if you are unable / unwilling to undertake an examination of the back at that point in time

i am somewhat alarmed that people seem to be quite happy to leave patients on longboards or indeterminate amounts of time , yet suggest they are acting as thepatient's advocate by maintaining a course of action which is acknowledged to be harmful to the patient.

ZippyGBR, BSN, RN · Dec 10, 2007

craig nice to see someone else who can look beyond the dogma, just a shame that others allow the dogma to be reinforced - especially when others have done the leg work and taken the 'risk' in developing and validating assessment tools such as the canadian C-spine rule

i think you are correct in assuming that that some of the other posters i nthis thread have not differentiated between removing the long board once extrication and transport is completed versus the actual clinical clearance of the C-spine - which is where the CCR comes in...

ERbunny · Dec 10, 2007

I work at the same facility as CraigB, and we have very defined criteria for taking patients off of boards, one of which is that they must be sober and cooperative. We have been following our protocol for at least 5 years without problems. It requires a team approach of 4 people and alleviates a lot of pt discomfort. We do keep them boarded if there is any question of injury, until the MD ses them.

mmutk, BSN, RN, EMT-I · Dec 11, 2007

rationale?

Well, for example see http://books.google.com/books?id=A59_r8FQrawC&pg=PA697&lpg=PA697&ots=gMING4e0RG&dq=nurse+sued+for+removing+patient+backboard+lawsuit&output=html&sig=dN4hYYIZqjDCztUsfOuYwtZGyzY

notice paragraph 5 and 6 states the lawsuit against the doc was because the backboard was removed prior to radiological evaluation of the spine and IT WAS BROKEN. Luckily a doc took it off and he got sued. If you think this won't apply to you (nurse) when you take someone off a backboard with a broken back, think again.

ZippyGBR, BSN, RN · Dec 11, 2007

Well, for example see http://books.google.com/books?id=A59_r8FQrawC&pg=PA697&lpg=PA697&ots=gMING4e0RG&dq=nurse+sued+for+removing+patient+backboard+lawsuit&output=html&sig=dN4hYYIZqjDCztUsfOuYwtZGyzY
notice paragraph 5 and 6 states the lawsuit against the doc was because the backboard was removed prior to radiological evaluation of the spine and IT WAS BROKEN. Luckily a doc took it off and he got sued. If you think this won't apply to you (nurse) when you take someone off a backboard with a broken back, think again.

you have failed dismally to demonstrate a rationale relying solely on an anecdote and misapplication of that anecdote ....

1. the cord injury was dicovered some hours after the initial incident, so quite possibly after transfer to an inpatient unit where nursing and medical staff may have been under the impression that the neck and back were cleared.

2. According to the anecdote there were failures in clinical examination and the determination of which and when plain films should be performed ...

3. This scenario is very different from the situation where a correctly performed removal from the board and re-institution of spinal preacutions pending a complete physical examination by an appropriate provider and radiology as indicated by the findings of the clinical examination, this patient has been transferred from ED trolley (?to a bed) to an operating table and back to bed apparently without spinal precautions ...

mmutk, BSN, RN, EMT-I · Dec 11, 2007

Well I'm not here to argue with you. It's just my opinion that every patient is different, but the one time you take a patient off a backboard with an acute C T or L spine fx, prior to xrays; you are most likely facing a lawsuit and you will have plenty of time to practice your legal aspects then.

RN1980 · Dec 11, 2007

zippygbr i belive you have failed dismally to convience me as well as others on this board that the patient as well as the nurse has more to gain by taking it upon themselves to remove the back board before being medically cleared or given a verbal ok. you have your way of doing things with the evidence that you have and i and ohters have our way with our beliefs in the best intrest concerning the patient and ourselves. i believe we have all made our points many times though that they are different. so we might as well shut the post down...