Neurological Assessment: Nurse Followed Hospital Policy

Neurological Assessment: Nurse Followed Hospital Policy - Court Blames Sitter.

Legal Eagle Eye Newsletter for the Nursing Profession

August 1998

Quick Summary: The nurse found the patient fully intact at the beginning of the night shift.

Later that night the sitter helped the patient to the bathroom, but did not report she was leaning to one side and unable to stand.

After the first 24 hours after surgery, if there were no specific physician’s orders, a nurse was required to perform a neurological assessment of the patient only at the beginning of the shift. COURT OF APPEAL OF LOUISIANA, 1998.

The patient was doing well at the start of the night shift the second day after surgery to install a shunt to divert fluid which had been building up inside her cranium causing hypertrophic encephalitis.

According to the Court of Appeal of Louisiana, standards for post-operative nursing care at the hospital called for the nurse to perform regular neurological assessments in the first twenty-four hours after surgery. After that, assuming the physician had not written explicit orders for more frequent neuro checks, the nurse was to perform a complete neurological assessment only at the beginning of the shift.

In this case, the nurse performed a neurological assessment at the beginning of the night shift, and found the patient fully intact. Then the nurse checked on the patient every two hours during the night, but did not wake the patient. The nurse checked with the private-duty sitter the family had hired. The sitter reassured her the patient was doing fine.

In fact, according to the court, the sitter had twice helped the patient to get up to go to the bathroom. The first time the patient did fine, but the second time the patient was leaning to one side so badly she could not stand. The sitter got two aides to help put the patient back to bed, but did not notify the nurse or tell the aides to tell the nurse. The patient was having a one-sided fluid build up in her cranium. She became paralyzed and sued.

The court did not fault the nursing care of this patient. The sitter was ruled at fault. Milazzo v. Home Care, 708 So. 2d 1108 (La. App., 1998).