Changing the way you learn

INCREASED ICP

ICP level substained greater than 20 mmHG
1. ICP level treated per nursing protocol
  1. Mannitol Given
    1. ICP continues to rise
ICP increases to 50mmHG. protocol states Neurosurgeon needs to be informed
1. Neurosurgeon paged through answering service for new order
  1. No response from MD. Home and cell phone called.
    1. No response from MD. police sent to MDs house. To check status of MD
Family's anxiety level increases over the increased ICP level in their son and what seems, lack of concern in nursing staff
1. Charge nurse intervenes and assures the family that their son is getting the full attention of the staff.
Primary nurse reaches out to hospitalist for guidance of care.
1. Hospitalist defers intervention at this time since he is not assigned to patients care team. Will provide guidance if unable to reach MD.
Neurosurgeon returns call and irate about being woken up.
1. Lectures nurse on appropriateness of disturbing MD at home.
2. Refuses to provide orders to Primary nurse or charge nurse
Charge nurse calls Intensivist and request orders for increased ICP since neurosurgeon did not give orders
1. New order received from intensivist.
2. Intensivist calls neurosurgeon and both meet in unit
Meeting held between all those involved in patient safety issue
1. New protocols
  1. ICP protocol was changed to give the nurse increased options to treat an elevated ICP.
2. Neuro ICU on call coverage
  1. Neurosurgery will defer primary care to the intensivist

INCREASED ICP

	Created by John Johnson almost 8 years ago