Are we able to comply with the NICE head injury guidelines?

Background: An estimated 120 000 patients are admitted to hospital in England and Wales each year for neurological observations following a head injury. The National Institute for Clinical Excellence ( NICE) has issued guidelines on the quality and frequency of neurological observations that should be made. Objective: Review of frequency and quality of observations in one trauma unit. Study design: Prospective audit of current practice. Method: Data on 100 consecutive patients admitted to a trauma unit for neurological observations were audited to monitor the consistency and frequency of neurological observations requested by the admitting doctor. Medical staff had previously been briefed on the recommendations of the NICE head injury guidelines. Results: A detailed evaluation revealed inconsistency and inexplicable gaps in observations. No single set of observations was complete. Sequential regular monitoring was difficult for many reasons, bringing into question the safety and reliability of current practice. Conclusions: The introduction of the new guidelines which recommend more frequent neurological observations has major staffing implications, where underperformance raises significant clinical governance issues. All hospitals admitting patients with head injuries should have an established protocol based on the NICE guidelines with observations recorded on an appropriately designed data collection form. Trained nursing staff have enormous work and time pressures including direct patient care, ward rounds, drug rounds, administration, management, and responding to emergencies. The development of a competency based training programme for auxiliary nursing staff to undertake neurological observations, including when to report concerns, is one solution to reduce the pressure on trained nursing staff.