Reporting on Neurological Decline as Identified by Hourly Neuroassessments.
Marcus Brazel, Jennifer Harris, Dawn Carroll and 4 others
PMID 38833429WHAT IT FOUND
In 212 neuro-ICU nursing shifts, 30 had neurological decline; 20 of 30 were found during scheduled hourly neurochecks, compared with 10 during other care.
Yet only nine of 20 led to treatment changes.
Key findings
01Of 30 neurological declines, 20 were identified during scheduled hourly neurochecks and 10 during other care, with scheduled detection significantly higher.
02Among 20 declines identified on scheduled neurochecks, nine led to a change in management and 11 did not.
03Subarachnoid hemorrhage patients were more likely to have a neurological change, while elective post-operative craniotomy patients were less likely.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It was done in one neuro ICU, so it may not apply to other units. It was a nurse survey, so self-selection and under- or over-reporting are possible. Nurse experience was not recorded. The survey could not tell when in a patient's course decline happened, whether a patient declined more than once, or whether a treatment plan should have changed but did not. It counted shifts, not individual patients, and the sample size may not be enough for definitive conclusions. The diagnosis-related findings were post-hoc.
Declared interests
All authors report no disclosures.
The easy way to misread this
Do not conclude that hourly neurochecks can be stopped because only 45% of identified declines changed management. This was a single-ICU nurse survey, not a safety trial, and the authors say risks and benefits need further study.