What does ‘routine post-op neuro obs’ really mean? Establishing a guideline

Background:
Neurosurgery carries a risk of post-operative deterioration that can be detected using neurological observations (NO). NO are frequently requested by surgeons using the phrase ‘routine post-op neuro obs’. There is no agreed definition of what this means.

Aims:
To identify the range of possible interpretations of the phrase ‘routine post-op neuro obs’ by nurses and surgeons.

Method:
National policy analysis, literature review, notes audit and survey methods were used to identify national and local practice. Data were analysed descriptively using Excel.

Findings:
Two out of 15 policies contained observation guidance. Fifteen surgeons used five terms to describe post-operative observations. ‘Routine’ was used to describe observation frequency anywhere between every 15 minutes and every 4 hours. Nurses varied in their interpretation, and frequency was based on clinical judgement.

Conclusion:
Post-operative instructions and nursing practice vary. There is a need and desire for clear evidence-based guidelines to ensure consistency and patient safety.