Top of the Charts: Detecting neurological deterioration more efficiently through improved documentation

Abstract

Abstract The Glasgow Coma Scale is a practical tool, accepted and utilised worldwide, to assess a patient’s conscious level. Despite the introduction of other tools, the Glasgow Coma Scale still remains the most reliable and effective method of detecting neurological deterioration. Detecting neurological change in an individual requires skilled observation and must rely on the ability of the clinician to carry out an accurate and reliable assessment. A large limitation of the Glasgow Coma Scale is that observer assessments may vary from clinician to clinician. What one individual may observe as neurological deterioration, another may not notice. It was recognised by senior nursing staff that if a neurological chart could be designed, that enhanced the ability to see the trends in a patient’s conscious level and instructed clinicians on when to report a finding, deterioration may be identified earlier and managed more efficiently. This study outlines a new neurological chart implemented at a busy private hospital in Melbourne and discusses the impact that clear and concise observation and documentation has on the ability to detect neurological deterioration.