Spinal, or Suspected Spinal Injury

Transcription

1 Approved by: Spinal, or Suspected Spinal Injury Vice President and Chief Medical Officer; and Vice President and Chief Operating Officer Corporate Policy & Procedures Manual Number: VII-B-150 Date Approved October 21, 2015 Date Effective November 6, 2015 Next Review November 2018 Purpose Policy Statement Applicability This document provides guidelines for the provision of care to the patient who has been placed on spinal precautions due to suspected or confirmed spinal cord injury. Covenant Health patient care providers shall adhere to the requirements outlined in this policy and procedure, and the accompanying series of Spinal, or Suspected Spinal, Injury procedures, when caring for patients with suspected or confirmed spinal injury. This policy and the corresponding procedures apply to all Covenant Health facilities and the staff and physicians who assess or care for patients with a suspected or confirmed spinal injury. *Please see attached algorithm addendums for procedure modifications for Sites/Units which may not have adequate resources to perform this procedure as outlined.* Responsibility Covenant Health physicians and staff involved with providing spinal management care are responsible to ensure that they meet the following requirements: 1) The individual responsible for head control must have completed the Spine Management education program requirements or is a physician with experience in managing the spine injured patient. 2) The majority of staff assisting with the procedure must have completed the Spine Management education program requirements. 3) Staff who have not completed the Spine Management education program requirements may assist with the spine management procedures but must do so under the direction of the individual or physician who is taking head control. It is the responsibility of patient care provider staff to identify and search for appropriate education resources (listed in the Resources section of this policy/procedure) or access clinical support resources where the program is fully implemented. Principles The primary goal is to prevent further injury and disability and ensure emergent assessment, management and treatment of the patient with spinal cord injury. When spinal injury is suspected (or until the patient has been cleared by the responsible physician), full spinal precautions shall be used to maintain an anatomically neutral position. Techniques and/or equipment used to support an anatomically neutral position include; logrolling of patient for comfort and procedures transfer techniques to move patient from surface to surface

2 Spinal, or Suspected Spinal Injury Date Effective Nov. 6, 2015 Policy No. VII-B-150 Page 2 of 4 application and maintenance of C-spine collar and skin care placing the patient on an appropriate surface for spine management as ordered by the responsible physician spinal signs measurement Covenant Health Spine Management education program has been developed for patient care provider staff working in applicable departments. When patients present or reside on nursing units where Spine Management education has not been fully implemented, just in time training will be provided to these units by qualified staff from other units. Procedure Patients with suspected or confirmed spinal cord injury shall be placed on full spinal precautions. Full spinal precautions include maintaining cervical (c-spine), thoracic and lumbar spine alignment with patient transfer, turning and positioning. Spinal precautions can be initiated by any qualified staff member who has completed the Spine Management education program requirements and when it is suspected that a patient by virtue of mechanism of injury has sustained a spinal cord injury. The patient with suspected spinal cord injury should be immediately assessed by the responsible physician* and be prioritized for radiologic examination to occur within 30 minutes of arrival in the emergency department. Refer to Appendix A - the Canadian C- Spine Rule flow sheet. Patient s who require spinal precautions while being transported to other departments within the facility must be accompanied by qualified medical personnel who has completed the Spine Management education program. The extrication collar is to be applied to and worn by all patients with suspected/confirmed cervical spine injury where stabilization is required. For patients requiring prolonged stabilization, application of a Philadelphia collar by a Rehabilitation Medicine staff member within 24 hours is required. An order from a responsible physician* is required for sizing and application of the Philadelphia collar. The patient is to remain on spinal precautions until radiologic* and clinical* clearance has been completed by the responsible physician*, who then writes the specific orders to discontinue spinal precautions and removes the c-spine collar, if applicable. Spinal motion restriction and management care orders must be written to govern the spinal care requirements and activity limitations for the patient until all components of radiologic and clinical clearance have been achieved. These orders must be clearly documented on the patient care orders. Physicians and care provider staff shall review the patient care orders daily and prior to providing any treatment/intervention. Definitions Radiologic Clearance X-Ray confirmation identifies absence of structural deformity to spinal column secondary to injury. Clinical Clearance soft tissue assessment/manipulation of patient s neck which may include patient s verbal confirmation of absence of soreness or injury.

3 Spinal, or Suspected Spinal Injury Date Effective Nov. 6, 2015 Policy No. VII-B-150 Page 3 of 4 Responsible Physician Attending physician who must personally contact the AHS Regional Spine Service for definitive patient management orders. Qualified Staff - are health practitioners who are working within their respective practice Regulation under the Health Professions Act (or other legislation) and who are permitted to provide care in accordance with Covenant Health corporate or site/program based policy. Qualified Staff must have completed the Spine Management Special Clinical Competency Education Package. Personal Protective Equipment includes hand hygiene. Spinal Motion Restriction maintaining the patient in a neutral, in-line position while trying to protect the spine from further damage. Related Documents Appendix A Canadian C-Spine Rule Attached Algorithms: Misericordia, Emergency/DI Radiology Mgmt. of Spinal Precautions Killam Health Centre, Emergency/DI Radiology Mgmt. of Spinal Precautions Misericordia Unit 7 West (Medicine), Mgmt. of Spinal Precautions Misericordia, Medicine/DI Management of Spinal Precautions Vegreville, Management of Spinal Precautions Grey Nuns, Emergency/DI Radiology Mgmt. of Spinal Precautions Castor, Our Lady of the Rosary, Emergency/DI Radiography Grey Nuns, Medicine/DI C-Spine Management Grey Nuns, Unit 53 C-Spine Management Procedures related to this Policy: Spinal, or Suspected Spinal, Injury Logrolling Technique With C Spine Precautions, #VII-B-155 Spinal, or Suspected Spinal, Injury Logrolling Technique Without C Spine Precautions, #VII-B-160 Spinal, or Suspected Spinal, Injury Application and Maintenance of Extrication Collar, #VII-B-165 Spinal, or Suspected Spinal, Injury Collar Care Philadelphia Collar, #VII- B-170 Spinal, or Suspected Spinal, Injury Surface to Surface Transfer, #VII-B-175 Spinal, or Suspected Spinal, Injury General Care of the Patient,#VII-B-180 Spinal, or Suspected Spinal, Injury Spinal Signs Measurement, #VII-B-185 *Spine Management education program References Alberta Health Services University of Alberta Hospital, Stollery Children s Hospital, Mazankowski Alberta Heart Institute Patient Care Procedure (2009): Lifting, moving, or logrolling a patient in bed not including C-spine, Number Mount Royal College ACCN ER Stream Revisions June 6, 2014

4 Canadian C-Spine Rule For all alert (GCS=15) and stable trauma patients where cervical spine injury is a concern 1. Any High Risk Factor which mandates radiography? Age 65 yrs or older Or Dangerous Mechanism * Or Paresthesias in extremities or Weakness NO YES * Dangerous Mechanism Fall from elevation 3 feet or greater or 5 stairs Axial load to head i.e. diving MVC high speed of over 100 (km/hr), rollover, ejection Motorized recreational vehicle Bicycle struck or collision 2. Any Low Risk Factor which allows safe assessment of Range of Motion? Simple rear end MVC ** Or Sitting position in ED Or Ambulatory at any time Or Delayed onset of neck pain *** Or Absence of midline c spine tenderness YES NO UNABLE Radiology ** Simple Rear end MVC excludes Pushed into oncoming traffic Hit by bus or large truck Rollover Hitby HighSpeedVehicle *** Delayed i.e. not immediate onset of neck pain 3. Able to actively rotate neck? 45 o left and right ABLE Rule Not Applicable If: non trauma case Glasgow Coma Scale less than 15 unstable vital signs age less than 16 acute paralysis previous C spine surgery No Radiology Stiell IG, et al. The Canadian C Spine Rule versus the NEXUS Low Risk Criteria in Patients with Trauma. New Engl J Med 2003; 349:

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