Postfall Neurochecks. What's your protocol?

[horrorxgirl]

I was just wondering what type of post fall neurochecks that other facilities, mainly longterm care facilities, have in place. When I first started at my current job a few years ago, whenever a resident had an unwitnessed fall we would initiate neurochecks every four hours for 24 hours.

Within the last year they introduced a new protocol that seems pretty excessive to me, especially considering how short staffed we are many times. Now for every unwitnessed fall we do neurochecks every 15 mins times 4, then every 30 mins times 4, then every hour times 4, then every 4 hours times 4, then every 8 hours times 8. The neurochecks include a full set of vitals everytime. I had a lady fall at the beginning of my 12 hour shift yesterday and I had to do 13 neurochecks on her, 13 sets of vitals. Let me tell you how happy she was about that. I was the only nurse for 27 patients. And god forbid if you have 2 or more falls. It starts to feel like you don't have time for anything else. Anytime we find a resident sitting on the fall mat beside their bed for the 5th time in a day, we do these neurochecks. Some people fall every single day. If I suspected someone needed that many neurochecks, my butt would be on the phone with the doctor to see if maybe they needed to go to a hospital and have more extensive tests done. So because of this, most of the people I'm doing these checks on are the regular fallers in low beds who crawl out of onto their mat.

Maybe I'm just wrong about this and neurochecks are needed this much for every single fall, but if so, then they need to hire a person who's only responsibility is neurochecks. At my facility, this person would be very very busy doing only this! I just feel like it's another one of those facility liability things that is taking care away from my patients.

[tonyal]

For us no matter if it is witnessed or not neuro checks are done Q15 X 4, then Q hour X 4 then Q 4 hour X4. and most of the nurses have 45+ residents to take care of.

[demylenated, BSN, RN]

Mine is a 24 (25 actually - but called a 24 hour) hour neuro check much like yours.

q 15 min x 1 hour

q 1 hour x 4

q 2 hour x 2

q 4 hours x 2

Final 8 hour

[gentlegiver, ASN, LPN, RN]

If I suspected someone needed that many neurochecks, my butt would be on the phone with the doctor to see if maybe they needed to go to a hospital and have more extensive tests done. /quote]

Going to the hospital doesn't stop the insanity at my faculity. When the patient returns we have to start Neuro's on them and continue thru the whole course.

[hiddencatRN, BSN, RN]

Doesn't it suck? I went in to a patient's room right before he was due to be discharged and the mom said "Oh, he fell and hit his head, and I just thought you should know." I inwardly groaned and went and got our fall sheet to do the protocol. It does seem a little excessive.

[rainbowsandsunshine]

witnessed with head injury or unwitnessed = automatic neurochecks.

q15min x 1hr

q30min x 2 hr

q1hour x 4hr

q4h x 24hr

the worst is the frequent fallers.... Sometimes they fall so often that you cant even finish one sheet of neuro's before beginning another. Of course we have alarms, low beds and floor mats, but many of these people are skilled at turning off the alarms, and doing as they please. Just not enough staff to watch them 24/7 and they choose not to ask for help (i.e. USE YOUR CALL BELL!!!!)

[CompleteUnknown]

The same thing is starting to happen where I work. It seems excessive to me too for an unwitnessed fall with no evidence of head injury. I really wonder how effective this is in identifying a serious problem in the LTC situation. We know the residents so well, I can't help thinking that staff would identify a problem by noticing changes in the resident's general condition and mental state before picking it up by changes in neuro obs. I don't know if that's true though.

I also wonder how we can be so sure that, if we're going to be doing neuro obs at this frequency in LTC, why 24 hours is the magic number. What about slow bleeds? I'd love to know how what percentage of problems this sort of protocol is going to catch. Might be a good research topic!

[usafguy99]

When I still worked in LTC (just a month ago) our protocol was:

q15min X 4

q30min X 4

q1hr X 4

q4hr X 4

q8hr X 6

Could be a real pain in the butt at times - especially when our policy for a while was that EVERY fall required neuro checks - even if it was witnessed and there was no head involvement. We were so happy when that policy was changed to either unwitnessed falls or witnessed falls with head involvement.

[LoveMyBugs, BSN, CNA, RN]

Mine is for unwitnessed only (thank goodness)

q15X4

q30X4

q60x4

q4hX4

q8hX4

Plus we have to fill out an accident and incident report, plus an SBAR form, because we have to notify the MD, and our new policy is for any time you contact the MD you have to have one of the SBAR forms filled out, then we need to highlight the carepath that we followed in addition to the SBAR form, to show how/what we were thinking

[CompleteUnknown]

Okay, I see I haven't been reading these properly! Horrorxgirl, does your protocol work out to last something like 87 hours or have I got that wrong?

Usafguy, 71 hours for yours? And LoveMyBugs, 55 hours? Am I working these out properly?? And all this for an unwitnessed fall without suspicion of head injury?

Wow. I'm speechless. I wonder if there is evidence to support this? What about elderly people who fall at home and get taken to the ED? I can't imagine they do a CT scan without at least some evidence of possible head injury. And no-one is going to be doing any neuro checks when they go home. Perhaps we should be sending all unwitnessed falls to the hospital! I hardly dare think about the reaction of the paramedics and the ED staff to that idea!

LoveMyBugs, your description of filling out an SBAR form and highlighting care paths and so on makes me feel ill. It's a wonder we're able to say good morning to a resident without filling out a form first!

[LoveMyBugs, BSN, CNA, RN]

usafguy, 71 hours for yours? and lovemybugs, 55 hours? am i working these out properly?? and all this for an unwitnessed fall without suspicion of head injury?yup something like that, doing neuro checks forever, sometimes we can get the rcm to dc them, but then they are on alert charting for 7 days also

lovemybugs, your description of filling out an sbar form and highlighting care paths and so on makes me feel ill. it's a wonder we're able to say good morning to a resident without filling out a form first!

i had an issue with one of my vent patients i assessed him, the md was in the facility, i spoke with the md got the orders i needed and the md took a look at him before he left, well then my nurse educator reminds me i need to fill out the sbar form and a highlighted carepath because i need to prove how i critical thought about my patient and prove how i assesed my patient before contacting the md:uhoh3: not nice call or good job, but here is a stack of paperwork to prove to the dns and administrator that you a trained professional can critically think:clown:

i feel like i need to have the sbar & carepaths think for me, "uh excuse me all knowing md, but accourding to the carepath i think my patient has xyz and needs abc, but i am not sure, but that is what the paper is telling me"....sorry i am really annoyed with the sbar/carepath

[CompleteUnknown]

I had an issue with one of my vent patients I assessed him, the MD was in the facility, I spoke with the MD got the orders I needed and the MD took a look at him before he left, well then my nurse educator reminds me I need to fill out the SBAR form and a highlighted carepath because I need to prove how I critical thought about my patient and prove how I assesed my patient before contacting the MD:uhoh3: Not nice call or good job, but here is a stack of paperwork to prove to the DNS and administrator that you a trained professional can critically think:clown:

I feel like I need to have the SBAR & carepaths think for me, "uh excuse me all knowing MD, but accourding to the carepath I think my patient has XYZ and needs ABC, but I am not sure, but that is what the paper is telling me"....sorry I am really annoyed with the SBAR/carepath

Yep I can understand exactly how you feel. What a joke.