One of the main reasons that doctors admit patients to a hospital is to have them monitored by the nursing staff. This should be a safe environment for patients to receive treatment with careful monitoring by trained nurses to see how the patients are responding.
In some cases that I’ve seen as a Houston, Texas medical malpractice lawyer, the nursing staff monitoring has been so bad that I think that patients would’ve been better off going home. That way, if a family member saw something was wrong, they could always go back to the emergency room and get medical attention.
Part of proper nursing evaluation involves establishing and documenting a baseline. This is done through a comprehensive head-to-toe assessment. Then, with periodic reassessments, a good nurse applies critical thinking to look for changes. If there is a significant clinical change, it requires notifying the doctor.
If you think about the type of things that nurses evaluate in a hospital room, the first thing that comes to mind is vital signs. These include things like temperature, pulse (heart rate), and respiration rate. Vital signs are assessed, reassessed, and documented for every hospital as a patient. Either the doctor or unit protocol will specify how often nurses should assess vital signs.
In some patients, the physician may find cause to order neurologic assessments, or neuro checks. The doctor will specify how often the nursing staff needs to assess and document neuro checks. They typically include, at a minimum:
• Assessing basic vital signs.
• Assessing for changes in level of consciousness.
• Assessing orientation to person, place, and time.
• Performing a pupil exam to look at the size and reactivity of the pupils.
• Assessment of speech.
• Glasgow Coma Scale assessment.
• Checking motor, sensory, and deep tendon reflexes.
• A cranial nerve exam.
I’ve handled numerous medical negligence lawsuits where there were gaping gaps in the nursing documentation, when for many hours or even a whole day there was no documentation of the neurological assessment.
In one case that’s in active litigation, there was about a 12-hour gap during which there was no apparent nursing care. Shortly after the nursing shift change, family members pressed the new nurse to get the patient some medical attention. They ended up finding out that he had experienced brain bleeding, which had gone unnoticed by the absent registered nurse who failed to follow orders regarding neuro checks.
In March 2019, I read the violation report of a surveyor from the Centers for Medicare & Medicaid’s Services, which found Providence Health Center, in Waco, Texas, didn’t follow its own protocol for neuro- assessments. The violation report noted that the hospital’s own policy required its nursing staff to perform neuro- checks as ordered by a physician, and to notify the physician if there were any changes in the patient’s neurological signs.
The Medicare/Medicaid surveyor did a spot check of five patient records and found that four of the five record showed that nurses weren’t following physician orders, skipping essential neuro-checks.
Why neuro checks are important
Even subtle changes in a good neuro exam by a well-trained registered nurse can reveal critical information that should be immediately communicated to a doctor for medical evaluation. I’ve worked with expert neurologists in numerous cases who have said that a change in neurological status, such as mental status, can be the first sign that there’s something wrong requiring medical attention.
An abnormal neuro check can show signs of a cerebrovascular problem, like a stroke, an infection, an evolving brain injury, a medication overdose or reaction, a new neurological condition, or host of other medical issues.
If you’ve been seriously injured because of poor hospital, nursing, or physician care, then contact a top-rated experienced Houston, Texas medical malpractice attorney for help in evaluating your potential case.