We have all had a resident fall sustaining a significant head injury requiring hospitalization, simple right? What about the resident who is observed on the floor with no outward signs of injury? What do we do then? This is not a trick question but can be tricky all the same. A physical assessment with neuro checks is performed, all good, resident is fine. 

Fast forward, 24 hours later, resident unresponsive. What the heck happened? Transfer 911 to the local ER only to find out the resident has a subdural hematoma likely caused by “trauma.” But the resident was fine 24 hours ago, right? Wrong. The resident may have “appeared” to be fine 24 hours ago when indeed there was a bleed, symptoms weren’t evident immediately, resident experienced a slow, unnoticed decline/change in condition, and we were not aware. 

How do these things occur? Sadly, our residents are at high risk for head injuries related to falls and many times falls just happen. That said, there is some controversy as to what the “standard” is for performing neuro checks. After a little research, it appears that the old standby of q 15 minute, q 30 minute, q 60 minute checks is still considered best practice. Sure, it takes time and energy but what time is better spent than identifying a change in condition quickly and providing appropriate care timely? Please, click on the articles below and if in doubt stick with best practice and be sure your documentation reflects the assessment. It may not be new or in vogue, but it is always best to err on the side of caution. Stay well and stay informed! 

Standardizing the Frequency of Neurologic Assessment After Acute Stroke

SAFE from Falls – Anti-Thrombotics and Fall and Injury Prevention (Hospital Inpatient Population) Gap Analysis