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Post Fall Neuro Checks

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psalazar psalazar (New) New

What is the standard of practice for neuro checks after an unwitnessed fall or one that the resident hit his/her head?

unwitnessed fall or head involved = to er

neuros are post-fall x72 hours for any fall.

per standard neuros checks

turnforthenurse, MSN, NP

Specializes in ER, progressive care. Has 7 years experience.

Neuro checks immediately s/p fall. MD notified immediately and the patient goes down for a head CT. Neuro check frequency is usually Q4H afterwards, but for how long is at the MD's discretion.

Nascar nurse, ASN, RN

Specializes in LTC & Hospice. Has 34 years experience.

unwitnessed fall or head involved = to er

neuros are post-fall x72 hours for any fall.

per standard neuros checks

All unwitnessed fall or head involvement goes to ER? From a LTC factility? Been in LTC a long time and with several companies...never heard of this extreme policy. Lots of unnecessary transfers

cwgrlup85, ASN, RN

Has 5 years experience.

We have a policy where anyone on coumadin or blood thinners who hit their head be sent to er for ct, unless family refuses. Otherwise any fall with head injury notify physician and monitor for any change in condition. We monitor neuros every 15 mins x 1 hour, then every 30 mins x 1 hour, then hourly x 4 hrs, then every shift for a total of 72 hrs. That was the same policy at another facility I worked at.

We do neurochecks immediately after unwitnessed fall, then every hour for eight hours and qshift for 72 hours.

Chris81

Specializes in geriatrics,wound care,hospice. Has 33 years experience.

VS immediately with grips,speech,pupils,mentation. Repeat q 15 minx1hr,q30minx2hrs,q4hrsx24hrs,q shiftx72hrs. restart sequence c each fall(even when multiple falls occur within this time frame. Labor intensive c frequent faller(65

This is a personal policy of DON.

we have a release form if there is no apparent injury, the family can say no to ER trip. Many do refuse without known poss. head injury.

But yes, very many transfers. Wish I was in private ambulance business.

Cheers

My Mom just underwent surgery today for a partial hip replacement. She had an unwitnessed fall on Monday afternoon and we were told that she would have xrays that night. Never happened until the afternoon of the next day. She has Alzheimers and I hope the accident and the surgery doesn't hasten her death.

You might think it's extreme and causes lots of unnecessary transfers but I am more than a little mad over the fact they waited until the next day to obtain xrays when they could have sent her to the ER that night and had them done there.

Vinniesguy

Has 23 years experience.

Wouldn't send them out immediately unless there was a clear head injury, a change in GCS, were on anti-coags or the family insisted. I think nurses are quite capable of clinical judgement without passing the buck unless its the policy of the facility. Or if the resident is alert and oriented enough to tell you they banged their head - but even then regular neuro obs will alert you to any potential problems. We've had aged folk come in from LTC's for an unwitnessed fall and are really cranky because all they did was slide off the edge of the bed!

I have been in nursing for 33 years and typically the protocol has been neuros every 15 mins x 1 hour, then every 30 mins x 1 hour, then hourly x 4 hrs, then every shift for a total of 72 hrs. Except for the last facility I worked was in my opinion a little Overkill (in ALL their policies) but their neuro checks were like every 15 mins x 1 hour, then every 30 mins x 1 hour, then hourly x 24 hrs, then every shift 7 days Yes you read that right!!! EVERY HOUR x24 HOURS THEN EVERY SHIFT x7 DAYS!!!!! This is an LTC facility and many residents are confused and waking up every hour x24 hours and shining a light in their eyes and vitals and the entire neuro check will certainly cause them to be more confused and get up without assistance and fall over and over again. So when you have 3 people on neuro checks every hour, don't expect me to get any other patient care done let alone the charting and paperwork to go with it. They are over the top in so many areas.

We just have a form that asks for vitals, grip strength, pupil reaction, and whether the resident is alert, responds to stimuli or unresponsive etc. You do it every 2 hrs x4 then every 4 hrs x4 then every 8 hrs times 3 or 4.