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CS46
Clearing the Cspine: What a Pain in the Neck!
By Julie Dobbs, RN, BSN, & Carrie Sona RN, MSN, CCRN, CS-MSCNS, Barnes Jewish Hospital, St. Louis, MO
For further information, please contact: Jld1247@bjc.org
Purpose: Clearing the cervical spine of unstable or significantly altered mental status trauma patients is a challenge. Negative radiographic evidence of fracture is not enough to remove cervical collars placed in the field or in the emergency department. A consistent practice to remove collars on unstable trauma patients has been difficult to accomplish in our institution and often involves multiple services such as orthopedics and neurosurgery. This delay in clearing the cspine has lead to skin breakdown and occipital decubitus formation in our trauma patients.
Description: The surgical intensive care unit practice committee noted the incidence of pressure ulcers and the Trauma service responded to our concerns by heading a multidisciplinary team to meet and address the problem. A new protocol was developed to clear the cspine and a cost-effective alternative collar was implemented.
Evaluation and Outcomes: The recognition of this system wide problem resulted in a clinical guideline that has improved service care, system wide education enhancements on cervical collar care which has standardized care, provided process simplification, and new skill for nurses, system wide changes in cervical collar care which improved operational performance and patient safety, system wide monitoring to provide continual feedback and ongoing performance management and a change in cervical collar brand that represent approximately $120 savings per collar, resulting in significant savings to the patient and hospital.
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