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

[canoehead, BSN, RN]

rthis statement has been made a number of times by a number of people in such threads but is never referenced with statue law or professional regualtions to back this assertion up .

As far as I know there is no law, but hospital policy states the physician must evaluate the patient before they are removed from the backboard (in 4 hospitals where I've worked ER).

Also some docs are fairly possessive about laying eyes/hands on the patient themselves before taking pt off the backboard.

[Tonjia]

As far as I know there is no law, but hospital policy states the physician must evaluate the patient before they are removed from the backboard (in 4 hospitals where I've worked ER).

Also some docs are fairly possessive about laying eyes/hands on the patient themselves before taking pt off the backboard.

I would check with ENA or the American College of Surgeons Committee on Trauma.

[ZippyGBR, BSN, RN]

As far as I know there is no law, but hospital policy states the physician must evaluate the patient before they are removed from the backboard (in 4 hospitals where I've worked ER).

so despite assertions made it's not actually Illegal ...

this really isn't very good, as we encounter this issue on a regular basis in the area of clinical practice i currently work in ( SCI both acute and rehab), with none specialists maintaining a routine intervention for our patient group is 'illegal' or must be performed by a Doctor ...

Also some docs are fairly possessive about laying eyes/hands on the patient themselves before taking pt off the backboard.

Doctors are as badly behaved as Nursing and lay management let them be ...

[traumarns]

"Setting yourself up for a huge liability issue! I hear the word "SUE" really come into play here!!!!!!! Like others have mentioned, the results of a fall, or other injury can be easily seen witht he naked eye, or much more minute. For instance, today we had a very seasoned ER doc tell a pt that the CT brain looked ok after a fall, however, after we received the official radiologist read result, a subarachnoid bleed was noted!

So NO, we will not de-board someone before an MD sees them. We will board someone who needs to be without a doc becuase that is part of our responsibility."

what the heck does sah have to do with spinal immob?? and back boards??????

so lets just say the dude had a compression fx of lumbar- would you keep him on a board???? or better yet put him back on one?

cant stay on one forever-

cant go to the floor on one-

[ZippyGBR, BSN, RN]

what the heck does sah have to do with spinal immob?? and back boards??????

nothing at all, it's someone looking at clutching at straws to maintain the dogma, a diagnostic failure has little or nothing to do with safe and appropriate clinical practice

so lets just say the dude had a compression fx of lumbar- would you keep him on a board???? or better yet put him back on one?

cant stay on one forever-

cant go to the floor on one-

the long EXTRICATION board should be removed at the first appropriate juncture - this is during triage

if additional support is required for secondary transfer a vacuum mattress should be considered , else the patient should be immobilised on the ambulance trolley

there seems to be focus on C spine immobilisation by some of the posters to this thread, a long Extrication board provides

NO immobilisation to the C Spine and sub optimal immobilisation to the T and L spine and a positive hazard to the sacral area.

[MassED, BSN, RN]

i don't have a Masters, does a Nurse need to be a Nurse-Academic

to apply some critical thinking and look at the evidence base behind something

ARE YOU?

becasue if the patient remains on the long board they will get tissue damage to their skin , and potnetially of course this leads to

a pressure sore

which is, an iatrogenic WOUND which

- provides a route for infection

- will require treatment evn if it doesn't get infected

- is entirely preventable

- have you ever seen what happens with pressure sores in those with spinal cord injuries ... and leads them to extra hospitalisations for months at a time

are you ?

if you were to use a long board in a law enforcement setting

or without the flimsy (lack ) of justification you are using it would probably beedeemed an act of torture

but then again the US has some funny ideas aobut torture and risk management in healthcare ( four point restraints anyone - something seen only in a museum in most other places ...)

I am unaware of any case where early removal from a longboard has resulted in litigation and i cannot see any reason why if it is done correctly that there would be any reason for litigation.

I am aware of plenty of cases where unjustified and uncalled for restraint and the iastrogenic injury of patients has resulted in litigation, criminal charges and /or professional misconduct hearings...

geeez, Zippy, give it a rest already.

[MassED, BSN, RN]

Hell will freeze over before I de-board a fully immobilized patient without a doctors order to do so. I work in a trauma center and it would be completely inappropriate for any nurse to randomly decide to deboard someone. Depending on mechanism of injury, the patient will not be de-boarded until the c-spine is cleared. In any case, the patient will not be de-boarded until the doctor states or writes the order to do so.

In our ER, all immobilized patients are seen quickly by the MD to assess for board removal, so it really has never been an issue.

Certainly, no-one would argue that there are problems assosiated with prolonged boarding, but I think it could also be said that early board removal to avoid these problems takes the back seat to c-spine protection.

Given the choice between a pressure ulcer and paralysis from my fractured c-spine...I'll take the pressure ulcer every day of the week!

Given the option of retaining my license or risk losing it over early board removal, I'll opt to retain my license every day of the week!

In my ER, the trauma team is all experienced, TNCC certified, ACLS, PALS and NALS certified, and most are CEN certified. I personally have 24 years of ER experience and would not consider for one moment de-boarding a patient prior to MD eval. Policy or no policy, in the end it is MY license...and the patients future!

BTW: our policy clearly states that board removal is done ONLY after MD eval and either verbal or written order for removal. Some of the new "hot shot" "I'm so smart" "I'm just as competent as any doctor" "I want total autonomy" nurses will never understand this approach. We see them in our ER all the time. They don't last long.

Please God...If I am EVER in a situation where I find myself boarded and collared, PLEASE PLEASE PLEASE let me awake to find myself in a trauma center where nurses are not making the "educated" decision to deboard me!! They don't have xray vision or the training to make that decision. I have a very busy life God, and I need to be able to walk and move my body freely in order to perform my job and care for my family and farm. Please God, if I develop a pressure ulcer or experience any discomfort associated with the "big bad nasty uncomfortable board" I will ignore it and not hold you or anyone else responsible for it. My life and the free movement and perfect functioning of my body is significantly more important to me. So PLEASE GOD...let me arrive at a facility that will care for me appropriately and prioritize my presenting problems from a trauma perspective to ensure the BEST POSSIBLE long term outcome for me and my family! Thank you God!!

All great points.

[MassED, BSN, RN]

man thats way to long of a damn post to basically say that you consider yourself the supreme authority on spine board removal. I can see you in the near future just taking upon your self to remove a board in triage just because you did some type of rinky-dink phtls/tncc assessemnt and the pt ruptures a disk or a nerve. and as you are being bent over the table getting assaulted by a lawyer I'm sure you'll be thinking "hmm maybe I should've waited on that docs order" but at least the patient wont have a pressure ulcer...

AWESOME response. Just awesome.

L O V E it.

[MassED, BSN, RN]

well unless you, Craig (or Zippy) are the MD's (or D.O's or PA's or NP's) assigned and clear that patient, then you're operating outside of your nursing scope of practice. Some poster wrote that they have clear immobilization precautions in their ER, so in that case I can understand following policy, but for the majority of nurses in ER's (in the states), providers assess the spine while removing the backboard. It simply is not done any other way. I would caution that the nurses think of their license prior to operating as though you are the doc in a situation - how do you think that would stand up in court? Despite using reason, you are not the doctor. Zippy, you keep pointing out that nurses should exercise their clinical judgment, which of course occurs, but that does not replace the doctor in this situation. We do not assume the liability for removing the patient - that is on the MD.

And of course, Zippy, you will chime in, as you have to every person that has posted onto this thread. Really, what else can you possibly add to any of this? You believe you can clear a patient - as in palpating them and removing the board. Well go ahead and deliver that care, as long as you have M.D., D.O., P.A., or N.P. behind your name and are within your scope of practice, otherwise I'd be watching my back.

[MassED, BSN, RN]

rthis statement has been made a number of times by a number of people in such threads but is never referenced with statue law or professional regualtions to back this assertion up

and your point there is ?

so you are advocating causing harm to patients? U'll ask the question again what is so magical about a physician's hands when s/he applies the Canadian C-Spine Rule or inspects and palpates the rest of the back?

vs this being undertaken by any other suitable educated, trained and experienced Healthcare professional , regardless of the title on the diploma hung on the downstairs loo wall

are Nurses as Professionals incapable of making a clinical judgement ? especially when the way in which the judgement is reached is with a validated and internationally respected decision support tool ?

" the level of skill of the ordinary man professing to hold that skill "

there are a significant number of validated and approved selective immobilisation guidelines in existence they are used by all kinds of health professionals in many places around the world to make decisions on whether there are clinical indications for immobilisation,

by causing harm and assaulting a patient ?

can you prove this assertion ? once again i return to the point made previously about the absence of proof of the assertion that a it is 'illegal' for a Nurse to remove a patient from a device known to cause iatrogenic harm when inappropriately or injudiciously used without an 'order' from a Doctor...

removing the backboard does not 'clear' the patient, however 'clearing' the patient is within the scope of Nurses and health Professional paramedics as can be seen by those places who use nexus/CCR or the JRCALC selective immobilisation guideline to make the assessment as to whether 'precautionary' immobilsation is justified without good clinical evidence of need.

Zippy, there really is no point. You are not understanding, and it seems you never will. Good luck in your nursing practice. I hope we shall never meet.

[mamamerlee, LPN]

Wowee wow wow! There are obviously some very passionate people here! Part of the problem is getting a doc to see the pt on a TIMELY basis.

As I stated earlier, my hubby was transported on a scoop litter due to acute angles in our apartment, then forced to wait OVER AN HOUR in the ER before an MD came to see him. He had NO HISTORY of back/neck injury. He does have Cerebral Palsy, and the forced immobilization made him go into horrific muscle spasms. This was completely uncalled for, and I wish someone would have had some common sense......

[Tonjia]

nothing at all, it's someone looking at clutching at straws to maintain the dogma, a diagnostic failure has little or nothing to do with safe and appropriate clinical practice

the long EXTRICATION board should be removed at the first appropriate juncture - this is during triage

if additional support is required for secondary transfer a vacuum mattress should be considered , else the patient should be immobilised on the ambulance trolley

there seems to be focus on C spine immobilisation by some of the posters to this thread, a long Extrication board provides

NO immobilisation to the C Spine and sub optimal immobilisation to the T and L spine and a positive hazard to the sacral area.

Thank you! someone finally said it! Long boards are for extrication and transport, nothing else. Who remembers when EMS used to do standing longboards???