Diário da Espinha

Post-Operative Neurological Observations, Are You Getting What You Ordered?

Abstract

Donald Buchanan, Gemma M Smith, Naveed Akhtar, Melvin Grainger and Adrian Gardner

Introduction: An audit at our spinal unit in 2006 highlighted the need for a consistent approach to neurological observations in spinal surgery patients. A protocol was therefore introduced for use throughout the hospital. The aim of this audit was to assess compliance with protocol for post-operative neurological observations over the course of two subsequent audits.

Materials and Methods: This was a retrospective audit. Patients selected were those admitted to the spinal unit in May 2006, February 2012 and August 2014. The case notes of 39 patients who had spinal surgery were reviewed against our gold standards on post-operative neurological observations. The mean age of the patients was 46 years (17 years to 80 years). The procedures performed included decompression, fusion, scoliosis correction, discectomy and tumour excision. Each patient’s case notes were examined to identify whether an operation note was produced, whether neurological observations were requested and if so, how frequently and whether this requested was complied with during the post-operative period. The location of the patients was also noted, as well as if any deterioration was reported to a doctor and if they subsequently acted accordingly.

Results: Over the period of three consecutive audits an overall improvement was seen regarding compliance with the standards set out in the protocol.

Conclusion: Clinical audit was used to highlight problems with post-operative monitoring of neurological function in spinal patients; further evaluation and implementation of the recommendations resulted in sustained improvement in delivery of healthcare.