Original Research: Practice Variations in Documenting Neurologic Examinations in Non-Neuroscience ICUs

Abstract

Patients admitted to an ICU require constant monitoring to assess the need for and effectiveness of interventions. Comprehensive serial assessments are important for timely diagnosis, detection of status changes, treatment planning, monitoring patient response, and optimal patient outcomes. 1 The neurologic examination (neuro exam) is a vital part of such assessments. A comprehensive neuro exam includes assessing seven domains: consciousness, injury severity, speech, cranial nerve function, pain, motor function, and sensory function. 2 The neuro exam is performed to assess for deterioration in a patient's consciousness and to detect new focal neurologic deficits, which can happen quickly and may result in worsened short-or long-term morbidity. 3 Documentation is a critical part of team members' communication across shift handoffs and level-ofcare transitions. Yet the degree to which both the performance and the documentation of the neuro exam correlate is not well established. Moreover, while a comprehensive neuro exam is commonly required for patients admitted to a neuroscience ICU, some form of a neuro exam is recommended for patients in all ICUs. 4 There has been little research examining which components of the neuro exam are assessed in the medical ICU (MICU), surgical An observational study reveals differences in charting by RNs versus providers.ICU (SICU), and cardiovascular ICU (CVICU), where patients with primary neurologic problems are admitted less often. 4Study purpose. This study examined documentation practices to identify the frequency and components of the neuro exam typically documented by RNs and by providers when caring for patients in the MICU, SICU, and CVICU. (For this study, providers included medical fellows and resident or attending physicians, NPs, and physician assistants.) BACKGROUNDNeurologic complications can and do occur in patients with or without a primary neurologic diagnosis. 5,6 This includes transient neurologic conditions as well as severe complications. For example, patients admitted to a MICU, SICU, or CVICU are at increased risk for developing delirium secondary to a host of health care-associated events. 7,8 In more extreme cases, a postsurgical CVICU patient could experience acute ischemic stroke, or a MICU patient's level of consciousness could progress to coma as a result of metabolic derangements. 9, 10 Clearly, neuro exams are critical to patient care in every ICU.In the neuroscience ICU, the neuro exam is typically highly detailed, designed to evaluate the functional status of every component of the ner-

Validation of a Novel Neurologic Assessment Test for Healthcare Staff

“…Resultantly, an argument has been made for more standardized training in particular skills and frequently used scales given the widespread demonstrated marked variation in training. 17,18 Individual institutions' policies, practices, and attitudes play a significant role in the learning process for practitioners. 12 Within teaching hospitals, a culture exists that promotes a shared learning experience between all practitioners, and this shared ideal can positively impact efficacy of delivered care.…”

“…Resultantly, an argument has been made for more standardized training in particular skills and frequently used scales given the widespread demonstrated marked variation in training. 17,18…”