neurovascular observations more than just a tick! - …cherylkimber.pdf · neurovascular...
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Neurovascular
Observations – more
than just a tick!
Cheryl Kimber ONP
Larissa Bailey CN
Flinders Medical Centre
Adelaide, South Australia
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Why?
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Neurovascular Observation
Neurovascular obs – fundamental nursing
observation and monitoring skill
Basic observation undergraduate education
Prevention compartment syndrome
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Why change
Observation by clinical nurses – inconsistencies in
accuracy, useful information
What does CWMS √ mean
Current policy & NV Chart poor tool for collection of
important/relevant information
Documentation varied
Lack understanding significance of NV results
Useful Information = Timely action
Adverse events required action
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Was there a problem to be fix
(was it broke!)
Audit taken over 2 weeks by a retrospective review of patient’s case notes from wards
44 notes total reviewed – various orthopaedic and non orthopaedic wards
All patients required NV obs casts, lower limb or upper limb surgery (NOF’s) at risk NV compromise
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Results
Nerve blocks – tibia
No neurovascular observations charted at all for couple patients (same ward)
Post surgery at 12 hours lower limb surgery no documentation by nursing staff
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Neurovascular Observations
Performance
This graph shows the usage of the neurovascular observation methods on 4 surgical wards audited.
Time Period - 2 week Audit
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Brainstorming
Nurses
Medical colleagues
Policy/chart expert designers
Multi speciality consultation
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Result
New Policy/procedure
New Chart
Upper and lower Limb
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Parameters tested
Nerve Block
Pain –increasing, on active or passive movement
Colour, warmth –descriptive terms
Venous return – quantified
Pulse
Testing specific motor and sensation characteristic
Swelling, Ooze - descriptive
ABSENTS OF THE TICK METHODOLOGY
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New Charts
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Ulnar nerve Radial nerve
Median nerve Deficit to median nerve
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Education Strategies
Inservice
Moodle
Consultant - expert
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Current status
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Sustainability
NV chart – frequency
Medical records
Preoperative issues
Medical team
Non orthopaedic area/wards
Ongoing education required
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Orthopaedic Nurse driven
Making difference
Filling the gap
Improving practice
Patient outcome
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References: Altizer L (2002) Neurovascular assessment. Orthopaedic Nurse 21 (4): 48-50.
Edwards S (2004) Acute compartment syndrome. Emergency Nurse 12 (3): 32-8.
Judge NL (2007) Neurovascular Assessment. Nursing Standard. 21 (45) 39-44
Love C (1998) A Discussion and Analysis of Nurse Led Assessment for the
Early Detection of Compartment Syndrome. Journal of Orthopaedic Nursing
2(3): 160-167.
Middleton C (2003) Compartment Syndrome: the importance of early diagnosis.
Nursing Times. 99 (21) 30-32