OUTREACHER. NEON: Working towards Provincial improvements in neurosurgical service delivery. Inside this issue. July 2017

Transcription

1 OUTREACHER Issue 2, Volume 1 July 2017 In 2011, the Ministry of Health and Long Term Care (MOHLTC) requested Critical Care Services Ontario (CCSO) to lead a planning process to develop a comprehensive neurosurgical system to meet the needs of adult and paediatric patients across Ontario. As a part of this program, the MOHLTC also committed new nursing positions, including clinical Neurosurgical Outreach Nurse and Neurosurgical Nurse Educator positions, to support the management of specialized paediatric and adult neurosurgical patients. The Neurosurgery Education and Outreach Network (NEON) was established in May 2013 to work in collaboration with the Provincial Neurosurgery Advisory Committee to support the educational component of recommendations to better integrate access to neurosurgical services in the province. Originally comprised of Nurse Educators and Program Directors from each of the province s adult neurosurgical centres, their work formed the foundation for an educational outreach program designed to provide a wide breadth of education to non-neurosurgical centres on neurosurgical patient s care across the continuum. The expanded network has grown to include Clinical Nurse Specialists, Advanced Practice Nurses and Nurse Practitioners working in both adult and paediatric neurosurgery. The OUTREACHER Newsletter will be published three times per year to provide regional hospitals with Neurosurgery updates and education. NEON: Working towards Provincial improvements in neurosurgical service delivery Inside this issue Subdural Hematoma (SDH): pp. 2-3 Educational Opportunities in your LHIN: pp. 2-3 Cauda Equina: pp. 4-5 What s New- Guidelines for Basic Paediatric Neurological Observation: pp. 5 Who to contact in your LHIN: pp. 6 IMPROVING ACCESS IMPROVING QUALITY AND RESPONSIVENESS IMPROVING NEUROSURGICAL NURSING CARE ACROSS ONTARIO

2 2 Subdural Hematoma (SDH) A subdural hematoma results from bleeding under the skull and on top of the brain between the dura mater and arachnoid layer. Subdural hematomas may be caused by a fall, trauma, MVC, assault or can be idiopathic. If a person has a bleeding disorder or takes blood thinners they are more likely to develop a subdural hematoma. Three classifications of SDH Acute Time Interval: Up to hours CT Imaging: Clotted blood that is hyperdense and crescent shaped Causes: Major traumatic brain injury (TBI) Subacute Time Interval: 2 days to about 2 weeks CT Imaging: Blood products and fluid that is isodense Causes: Slowly expanding acute SDH Chronic Time Interval: Longer than 2 weeks to several months CT Imaging: Fluid mass that is hyperdense Causes: Minor trauma in the elderly, bleeding disorder or anticoagulants Symptoms Headache, confusion, change in behavior, dizziness, nausea and vomiting, lethargy or excessive drowsiness, weakness, apathy, seizures, motor weakness Signs Increased intracranial pressure Decreased level of consciousness Changes in mental status, confusion, lethargy Unequal and/or sluggish pupillary responses Seizure activity EDUCATIONAL OPPORTUNITIES IN YOUR LHIN! LHIN 2 May 16: Woodstock General Hospital ER Skills Fair LHIN 3&4 May 25: Welland General Hospital Neuro Assessment ER May 25, August 9 & 30: Niagara Health System Neuro Assessment ER May 26: Greater Niagara General Hospital ER MD spine education June 12: Greater Niagara General Hospital Neuro June 13: Niagara Health System ER MD Emergency Guideline for consultation education June 28: Mohawk College Sim. Train the Trainer workshop (IPE) August 30 & 31: West Lincoln Memorial Hospital Neuro Review LHIN 5&6 May 12: Headwaters Healthcare Centre Cervical Collar Care and Management (Hands-on) (2:00-2:45pm) May 18 & 25: Oakville-Trafalgar Memorial Hospital SIMS day ER with neurological assessment and scenarios (10:30-11:30am) June 6: Brampton Civic Hospital Neuro Assessment and Scenarios (11-12pm, 12-1pm, 1-2pm) June 22: Etobicoke General Hospital Cervical Collar Care and Management (Hands-on) (1-1:45pm, 2-2:45pm, 3-3:45pm) August 9: Headwaters Healthcare Centre Craniectomy Care (11:00am) LHIN 10 May 10: Kingston General Hospital Post-operative Neurological Assessment PACU (8:00am-9:00am) May 21, 26, 29 & 31: Lennox & Addington County General Hospital- Neuro assessment and case study LHIN 11 May 9: Winchester District Memorial Hospital Skills Fair

3 3 EDUCATIONAL OPPORTUNITIES IN YOUR LHIN! (Cont d) Neurosurgery Outreach education days May 10: Cornwall Community Hospital Skills Fair LHIN 14 May 16: Red Lake Margaret Cochenour Memorial Hospital (10:00-4:00pm) May 17: Meno Ya Win Health Centre (9:00-3:00pm) May 18: Dryden Regional Health Centre (11:00 4:00pm) May 23: Atikokan General Hospital (10:00-3:00pm) May 24: La Verndrye Hospital (10:00-3:00pm) May 26: Lake of the Woods District Hospital (9:00-2:00pm) June 14: Nipigon District Memorial Hospital (10:00 3:00pm) June 15: Geraldton District Hospital (10:00-3:00pm) June 20: Manitouwadge General Hospital (1:00 5:00pm) June 21 & 22: North of Superior Health Care Group (10:00 2:00pm) Contact your Neurosurgery Outreach nurse Kim Belluz regarding neurosurgery education, Monday to Friday 8-4 at or Subdural Hematoma (SDH) cont d Signs Increased intracranial pressure Headache Hemiplegia Abnormal motor responses Vomiting (without nausea) Brainstem pressure signs (vital signs and respiratory changes) Investigations CT scan PT/PTT Treatment Depends on the classification: Acute: Craniotomy Subacute & Chronic: Usually managed with Burr hole drainage Craniotomy Craniectomy *Some SDH s may only require monitoring and no surgical interventions* References 1. Canzian, S. (2012). Traumatic brain injury. In D. Tymianski, A. Sarro & T. Green (Eds.), Navigating neuroscience nursing: A Canadian perspective (1 st ed.). Pembroke: Pappin Communications. 2. Greenberg, M. S. (2010). Handbook of neurosurgery (7 th ed.). New York: Thieme Medical Publishers. 3. Hickey, J.V. (2014). The clinical practice of neurological and neurosurgical

4 4 Cauda Equina Syndrome (CES) Cauda Equina Syndrome is compression of the lumbar and sacral nerve roots. Depending on the affected nerve roots, changes in motor, sensory, and/or bowel and bladder function may occur. If left untreated, paraplegia and/or bowel and bladder incontinence may occur (Strayer et al., 2010). Early recognition of the signs/symptoms and emergent surgical intervention can improve the outcome for patients experiencing CES. Causes Large disc herniation L4-L5, L5-S1 level most common cause Trauma e.g. fractures Tumour Spinal Stenosis Hemorrhage Epidural abscess Symptoms Sphincter disturbance: Urinary retention, urinary and/or fecal incontinence, diminished anal sphincter tone Saddle Anesthesia: decreased sensation to anus, lower genitals, perineum, over buttocks, posterior-superior thighs Significant motor weakness Low back pain and/or sciatica: usually bilateral may be unilateral or absent (prognosis may be worse when absent or bilateral) Possible bilateral absence of Achilles reflex Sexual dysfunction Diagnosis Physical exam: determines nerve root involvement and level of impairment Motor Sensory Reflex function Post void residual: assess bladder function PVR with catheterization or bladder ultrasound Digital rectal exam-assess for saddle anaethesia Diagnostic imaging MRI Treatment Surgical decompression of nerves within hours. References RED FLAG! Loss of bowel and bladder control or function is considered a surgical emergency (Tymianski et al., 2012) 1. Strayer, A., Prendergast, V., & Henwood, A. (2010) Spine disorders. In M.K. Bader & L.R. Littlejohns (Eds.), AANN Core curriculum for neuroscience nursing (5 th ed., pp. 456). USA: American Association of Neuroscience Nursing. 2. Greenberg, M. S. (2010). Handbook of neurosurgery (7 th ed., pp. 446). New York: Thieme Medical Publishers. 3. Ahier, J., & Sarro, A. (2012). Paediatric and adult spine. In D. Tymianski, A. Sarro & T. Green (Eds.), Navigating neuroscience nursing: A Canadian perspective (1 st ed., pp. 142). Pembroke: Pappin Communications. 4. Hickey, J.V. (2014). The clinical practice of neurological and neurosurgical nursing (7 th ed.). Philadelphia: Lippincott Williams & Wilkins.

5 5 What s New! Guidelines for Basic Paediatric Neurological Observation The Guidelines for Basic Paediatric Neurological Observation provide direction for local development of bedside neurological observation protocols, in order to enhance existing skills and to ensure consistency of paediatric neurological assessment within and across different organizations. It is intended to enhance and build on current knowledge and skills. For the individual patient, this provides a baseline from which changes in the patient's neurological status may be identified, reported, and managed in a timely manner. These Guidelines were developed by the Neurosurgery Education and Outreach Network (NEON) in collaboration with Provincial Neurosurgery Ontario. Click here to view the OTN Presentation: Webinar-Guidelines for Basic Paediatric Neurological Observation Now offered through the OTN Hub! Please visit: For the latest neurosurgical guidelines and educational webinars

6 Who to Contact in your LHIN-Click on the name to connect via 6 LHIN Organization Neuro-Nurse Educator Clinical Outreach Specialist LHIN 1 Windsor Regional Hospital Sean Hopkins Sean Hopkins LHIN 2 London Health Sciences Centre Jean Morrow Kimberly Salway LHIN 3/4 Hamilton Health Sciences Brenda Bousfield Klaudia Gogishvili Sera Nicosia Tina Petrelli (Paeds) LHIN 5/6 Trillium Health Partners Beverly Espedido Beverly Espedido LHIN 7/8/9W/12 University Health Network Charmaine Arulvarathan Dawn Tymianski LHIN 7/8/9W/12 St. Michael s Hospital Wendy Legacy Wen-Ya (Lory) Lee LHIN 7/8/9W/12 Sunnybrook Health Sciences Centre Lars Kure Catherine Morash LHIN 7 The Hospital for Sick Children Elisabeth White Elisabeth White LHIN 9E/10 Kingston General Hospital Marnie Cranston Nicole Chenier-Hogan LHIN 11 The Ottawa Hospital Raizha Gramcko Dianna Hughes LHIN 13 Health Sciences North Sudbury Lisa Weiler Lindsay Roach LHIN 14 Thunder Bay Regional Health Sciences Centre Chad Johnson Kim Belluz