#WeNurses - Thursday 6th October 2016 8pm (GMT Standard Time) The Glasgow Coma Scale for adults: are we doing it right?

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This chat is guest hosted by @Ismalia_S @SueWoodward_KCL @NeuroNurseForum

The Glasgow ComaScale (GCS) is the gold standard for assessment and decision making in patients with acute neurological conditions at risk of deterioration (Teasdale and Jennett 1974; Middleton 2012; Teasdale et al 2014). Developed in 1970, it continues to be used to assess the level of consciousness in these patients.

It is fundamental that nurses have the knowledge that underpins this assessment and are able to identify deterioration when it occurs but:

  • When was the last time you were taught about how toperform a GCS assessment correctly?
  • How confident do we feel?
  • When you report and document your findings, do you use the score and/or do you use the scale?

Throughout the years, peripherally and centrally applied painful stimuli have been the subject of discussion (3) what are the differences between these two stimuli? And, when it comes to assessment of neurological deterioration, (5) is it only the GCS that matters?

We’ve come across clinical situations or factors that impact the way we perform the GCS and we had to overcome these but (6) which situations do you encounter in your nursing practice and how to you over come those? (7) do you always carry out a GCS assessment during nursing handover? How important is it to do it?

In 2014, Teasdale et al (2014) made new recommendations for the assessment of the GCS. However, not all hospitals across the UK have adopted them.

 This chat aims to promote best evidence based practice when using the GCS, help nurses develop their skills and provide answers to the most common questions related with this assessment.


Suggested reading:

Braine M,Cook N (2016) The Glasgow Coma Scale and Evidence-Informed Practice: a critical review of where we are and where we need to be. Journal of Clinical Nursing. Accepted Author Manuscript. doi:10.1111/jocn.13390.

Middleton P( 2012) Practical use of the Glasgow Coma Scale; a comprehensive narrative review of GCS methodology. Australasian Emergency Nursing Journal, 15, 170—183.

Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G (2014) The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurology, 13, 844–54.

Waterhouse C(2009) The use of painful stimulus in relation to Glasgow Coma Scale observations. British Journal of Neuroscience Nursing, 5, 5, 209-215.

Woodward S, Mestecky A editors (2011) Neuroscience Nursing: evidence-based practice. First edition. Willey-Blackwell. Oxford


About our Guest Hosts:

This chat is hosted by Ismalia de Sousa (@Ismalia_S), Dr Sue Woodward (SueWoodward_KCL) and the RCN Neuroscience Forum Steering Committee (@NeuroNurseForum)    

I’m Ismalia de Sousa, a clinical nurse specialist in stroke at Imperial college Healthcare NHS Trust and a member of the RCN Neuroscience forum Steering Committee. I’ve been a registered nurse for the past 7 years,working in stroke care. The Glasgow coma scale is a fundamental and day-to-day nursing assessment of patients with stroke or other neurological conditions at risk of deterioration and throughout the years I’ve always noticed how there was never a consensus when carrying out the assessment. How many times my GCS assessment was different from other nurses or doctors? I’ve lost count! Despite discussions around the use of peripherally and centrally applied stimulus, the GCS continues to be a gold standard assessment. This year, at the RCN Congress,the RCN Neuroscience Forum Steering Committee held a fringe event about the GCS and how to best assess patients using the GCS (https://www2.rcn.org.uk/newsevents/congress/2016/events/sunday/the-glasgow-coma-scale-doing-it-right).

Dr Sue Woodward is head of clinical education at Florence Nightingale School of Nursing and Midwifery. She has been a lecturer in nursing and worked in neuroscience nursing for more than 30 years and for a lot of times Sue has thought student nurses how to best assess patients using the GCS. Sue is also the Chair of the RCN Neuroscience Forum Steering Committee,founding Editor-in-chief of the British Journal of Neuroscience Nursing and actively involved in research focusing on bowel management in neurological conditions.






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 Chat Summary

 

A broad range of nurses and student nurses, who have been in practice for varying years participated in a Twitter chat. We learned the majority were only taught about the Glasgow Coma Scale (GCS) at university and while for student nurses this might have been in the last 3 years, for those with more years of experience, training took place 20 or 30 years ago. In addition, very few have had an update since.

Confidence is felt more in those who use it in their clinical practice every day in comparison with those that don’t, but this poses the question whether update training around the GCS should be mandatory, even in the areas that don’t regularly use it. If patients in these areas are at risk of clinical deterioration and a GCS assessment is needed, it is crucial that we can do this well!

The application of painful stimuli has been a source of debate over the years and has had multiple variations. However, if variations occur, it means that there is a need for training and standardisation of approaches. Nevertheless, the rule is the same: a centrally applied painful stimuli should be used when assessing the motor response component of the GCS and directed to the core of the central nervous system – a cranial nerve (CN) - such as the CN XI (spinal accessory nerve) using the trapezius muscle or the CN V ( Trigeminal nerve) using the ophthalmic branch of the nerve that lies in the supraorbital notch. @Ismalia_S highlighted in theTweet chat that exceptions may occur when assessing motor response (for example in patients with spinal cord injury). During discussion around painful stimuli, @SueWoodward_KCL raised the important fact that nurses should not be under-stimulating when applying painful stimuli, with some chat contributors sharing the fact they ask their students to practice applying the painful stimuli to each other.

Breaking down the GCS by using the components of the scale (E4, V4 and M6) and not only the score (e.g. GCS 14/15) is better to report clinical findings as the only scores that can be fully understood areGCS 3/15 and GCS 15/15.

We also discussed how other assessments and tools are important to assess neurological deterioration together with the GCS, such as the AVPU, limb assessment, pupil assessment, vital signs or even other specific tools that nurses use in their area of practice. The “Look, Listen and Feel” approach and our clinical judgement are also fundamental, and any variations from our baseline assessment should be reported.

Variations of age and disability, people with dementia, learning difficulties and language barriers may affect the way the GCS is carried out. Involvement of families in some of these cases may be appropriate.

Our last question focused on carrying out a GCS assessment during handover and it was great to see that student nurses are being taught to do it as this may reduce inter-rater reliability.





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 #WeNurses transcript

 
@WeNurses
06 October 2016 20:00
Welcome to tonight's #WeNurses Please tweet us a hello if you are joining us this evening https://t.co/eLa1A95FNJ
@Ismalia_S
06 October 2016 20:00
Hello everyone. We are now live. Who is out there? #GCSchat #wenurses
@AgencyNurse
06 October 2016 20:00
Hello Teresa here #WeNurses
@Ismalia_S
06 October 2016 20:01
Hello @AgencyNurse welcome! #wenurses #GCSchat
@WeNurses
06 October 2016 20:02
Tonight is all about the Glasgow Coma Scale and is being led by @NeuroNurseForum @Ismalia_S & @SueWoodward_KCL #WeNurses
@Marie_Batey
06 October 2016 20:02
Hello! @Ismalia_S and @WeNurses #WeNurses :)
@WeNurses
06 October 2016 20:02
So over to you guys ..... #WeNurses https://twitter.com/WeNurses/status/784106502990753792
@matthewvanloo
06 October 2016 20:02
Good evening everyone #WeNurses
@SueWoodward_KCL
06 October 2016 20:02
RT @WeNurses: Tonight is all about the Glasgow Coma Scale and is being led by @NeuroNurseForum @Ismalia_S & @SueWoodward_KCL #WeNurses
@Marie_Batey
06 October 2016 20:02
RT @WeNurses: Tonight is all about the Glasgow Coma Scale and is being led by @NeuroNurseForum @Ismalia_S & @SueWoodward_KCL #WeNurses
@Ismalia_S
06 October 2016 20:03
@WeNurses thank you! Let's kick things off! #WeNurses #GCSchat
@WeNurses
06 October 2016 20:03
@Marie_Batey @Ismalia_S hi Marie #WeNurses
@sprod_karen
06 October 2016 20:03
Hello I'm Karen, first year Adult Nursing student @obu_nurses #wenurses #GCSchat Will be lurking!
@WeNurses
06 October 2016 20:03
@matthewvanloo Hi Matthew #WeNurses
@Bartontd
06 October 2016 20:03
Evening All - #davewave lurking in #Swansea #wenurses
@knh_nqn
06 October 2016 20:03
Hi @WeNurses student nurse just getting to grips with chat #wenurses
@WeNurses
06 October 2016 20:04
Lurkers welcome #WeNurses https://twitter.com/sprod_karen/status/784106789277171713
@Ismalia_S
06 October 2016 20:04
@sprod_karen @obu_nurses Hi Karen! welcome #gcschat #WeNurses
@WeNurses
06 October 2016 20:04
Hello and welcome #WeNurses https://twitter.com/KathyHalson/status/784106893983805440
@Ismalia_S
06 October 2016 20:04
@KathyHalson @WeNurses what a wonderful first time then #gcschat #wenurses
@WeNurses
06 October 2016 20:04
@Bartontd Hi Dave #WeNurses
@HealthUKTD
06 October 2016 20:04
RT @WeNurses: In 15 mins Getting to grips with The Glasgow Coma Scale #WeNurses with @NeuroNurseForum https://t.co/WGrlDHSX8F #PenTorc…
@keeling_michael
06 October 2016 20:04
Hello @WeNurses @Ismalia_S michael here #wenurses :-)
@JFr4ser
06 October 2016 20:05
Hello from Glasgow. Kids bedtime to sort so might dip in and out #WeNurses
@SueWoodward_KCL
06 October 2016 20:05
@sprod_karen @obu_nurses welcome to #GCSchat #WeNurses have you learnt this skill yet?
@Ismalia_S
06 October 2016 20:05
@Bartontd welcome! good to have lurkers #wenurses #gcschat
@Bartontd
06 October 2016 20:05
RT @WeNurses: @Bartontd Hi Dave #WeNurses
@keeling_michael
06 October 2016 20:05
RT @WeNurses: Tonight is all about the Glasgow Coma Scale and is being led by @NeuroNurseForum @Ismalia_S & @SueWoodward_KCL #WeNurses
@WeNurses
06 October 2016 20:05
@JFr4ser feel free to dip away #WeNurses
@Ismalia_S
06 October 2016 20:05
So .. Q1 - when was the last time you were taught about how to perform a GCS assessment? #wenurses #Gcschat
@WeNurses
06 October 2016 20:05
Nice to have you here #WeNurses https://twitter.com/keeling_michael/status/784107193775878144
@WeNurses
06 October 2016 20:06
#WeNurses Great first question > https://twitter.com/Ismalia_S/status/784107397937790985
@keeling_michael
06 October 2016 20:06
RT @Ismalia_S: So .. Q1 - when was the last time you were taught about how to perform a GCS assessment? #wenurses #Gcschat
@PUNCdenise16
06 October 2016 20:06
Hi I am Denise a first year nursing student still getting to grips with tweetchat.#WeNurses
@AgencyNurse
06 October 2016 20:07
As a student nurse i think .... however no longer work in acute care #WeNurses https://twitter.com/Ismalia_S/status/784107397937790985
@_CharlLangley
06 October 2016 20:07
Hello, Charlotte here - student children's nurse from @nursingSUni #WeNurses
@matthewvanloo
06 October 2016 20:07
@Ismalia_S was first taught as a first yr student nurse. Used it regularly since. #WeNurses
@WeNurses
06 October 2016 20:07
@PUNCdenise16 Hi Denise - you are doing fab so far #WeNurses
@SueWoodward_KCL
06 October 2016 20:07
RT @Ismalia_S: So .. Q1 - when was the last time you were taught about how to perform a GCS assessment? #wenurses #Gcschat
@AgencyNurse
06 October 2016 20:07
RT @Ismalia_S: So .. Q1 - when was the last time you were taught about how to perform a GCS assessment? #wenurses #Gcschat
@Bartontd
06 October 2016 20:07
RT @WeNurses: #WeNurses Great first question > https://twitter.com/Ismalia_S/status/784107397937790985
@keeling_michael
06 October 2016 20:07
@Ismalia_S 15ish yrs ago... #wenurses
@WeNurses
06 October 2016 20:07
RT @matthewvanloo: @Ismalia_S was first taught as a first yr student nurse. Used it regularly since. #WeNurses
@Ismalia_S
06 October 2016 20:07
@PUNCdenise16 welcome! It's a great first one to start with. We have launched our 1st question #WeNurses #gcschat
@SueWoodward_KCL
06 October 2016 20:08
RT @Ismalia_S: @Bartontd welcome! good to have lurkers #wenurses #gcschat
@keeling_michael
06 October 2016 20:08
RT @WeNurses: #WeNurses Great first question > https://twitter.com/Ismalia_S/status/784107397937790985
@WeNurses
06 October 2016 20:08
@_CharlLangley @nursingSUni lovely to see you #WeNurses
@WeNurses
06 October 2016 20:08
RT @keeling_michael: @Ismalia_S 15ish yrs ago... #wenurses
@Ismalia_S
06 October 2016 20:08
any training at work? #gcschat #wenurses https://twitter.com/matthewvanloo/status/784107800104501252
@Marie_Batey
06 October 2016 20:08
Probably about 30 years ago! @Ismalia_S #gcschat #wenurses
@nadasj89
06 October 2016 20:08
@WeNurses @Ismalia_S back when I was a student during an ICU placement #WeNurses
@Bartontd
06 October 2016 20:08
@WeNurses Spent my entire career as a Nurse Teacher teaching GSC to student Nurses #wenurses
@Marie_Batey
06 October 2016 20:08
RT @Ismalia_S: So .. Q1 - when was the last time you were taught about how to perform a GCS assessment? #wenurses #Gcschat
@Ismalia_S
06 October 2016 20:09
that's a long time ago...any updates since? #gcschat #wenurses https://twitter.com/keeling_michael/status/784107890936340480
@_CharlLangley
06 October 2016 20:09
Taught in uni, I think in first year. Briefly used on spoke in PICU, but not since. #WeNurses
@WeNurses
06 October 2016 20:09
RT @Bartontd: @WeNurses Spent my entire career as a Nurse Teacher teaching GSC to student Nurses #wenurses
@SueWoodward_KCL
06 October 2016 20:09
RT @Ismalia_S: any training at work? #gcschat #wenurses https://twitter.com/matthewvanloo/status/784107800104501252
@Bartontd
06 October 2016 20:09
RT @matthewvanloo: @Ismalia_S was first taught as a first yr student nurse. Used it regularly since. #WeNurses
@JFr4ser
06 October 2016 20:09
@Ismalia_S As a student in class and on placement, as part of ITU ENB course, other ITU training/development years down the line #wenurses
@Marie_Batey
06 October 2016 20:09
@Ismalia_S It's interesting to reflect on the fact that I was taught it once though... and never since. #WeNurses #gcschat
@Ismalia_S
06 October 2016 20:10
@keeling_michael and @Marie_Batey you are on the same team! #wenurses #gcschat https://twitter.com/Marie_Batey/status/784108149154414592
@keeling_michael
06 October 2016 20:10
RT @Ismalia_S: that's a long time ago...any updates since? #gcschat #wenurses https://twitter.com/keeling_michael/status/784107890936340480
@WeNurses
06 October 2016 20:10
No problem - there are some details here >> http://www.wecommunities.org/tweet-chats/chat-details/2861 #Wenurses https://twitter.com/PUNCdenise16/status/784108306554052608
@matthewvanloo
06 October 2016 20:10
@Ismalia_S not something I have ever seen taught in practice. Always worked with people who were taught as students #wenurses
@Ismalia_S
06 October 2016 20:10
Some training even after uni! That's great to know #wenurses #gcschat https://twitter.com/JFr4ser/status/784108422321082369
@nadasj89
06 October 2016 20:10
RT @WeNurses: No problem - there are some details here >> http://www.wecommunities.org/tweet-chats/chat-details/2861 #Wenurses https://twitter.com/PUNCdenise16/status/784108306554052608
@SueWoodward_KCL
06 October 2016 20:11
@Marie_Batey @Ismalia_S you and me both! Interesting that nothing much has changed in thAt time #GCSchat #wenurses
@matthewvanloo
06 October 2016 20:11
@Ismalia_S *never not ever #WeNurses
@SueWoodward_KCL
06 October 2016 20:11
RT @Ismalia_S: that's a long time ago...any updates since? #gcschat #wenurses https://twitter.com/keeling_michael/status/784107890936340480
@AgencyNurse
06 October 2016 20:11
Yes i am having the same thought .. was taught but never had a refresh #Wenurses https://twitter.com/Marie_Batey/status/784108441283522560
@SueWoodward_KCL
06 October 2016 20:11
RT @Marie_Batey: @Ismalia_S It's interesting to reflect on the fact that I was taught it once though... and never since. #WeNurses #gcschat
@SueWoodward_KCL
06 October 2016 20:11
RT @Ismalia_S: @keeling_michael and @Marie_Batey you are on the same team! #wenurses #gcschat https://twitter.com/Marie_Batey/status/784108149154414592
@keeling_michael
06 October 2016 20:11
@Ismalia_S worked within neurosurgery and neuro icu, used it daily for a long time, not been updated since.. #wenurses
@Ismalia_S
06 October 2016 20:11
Has anyone else experience the same? #wenurses #gcschat https://twitter.com/matthewvanloo/status/784108559629946881
@AgencyNurse
06 October 2016 20:11
Was the teaching different ? Or the same sort of stuff ? #WeNurses https://twitter.com/JFr4ser/status/784108422321082369
@AgencyNurse
06 October 2016 20:11
RT @_CharlLangley: Taught in uni, I think in first year. Briefly used on spoke in PICU, but not since. #WeNurses
@keeling_michael
06 October 2016 20:11
RT @Ismalia_S: @keeling_michael and @Marie_Batey you are on the same team! #wenurses #gcschat https://twitter.com/Marie_Batey/status/784108149154414592
@WeNurses
06 October 2016 20:12
RT @Ismalia_S: Some training even after uni! That's great to know #wenurses #gcschat https://twitter.com/JFr4ser/status/784108422321082369
@SueWoodward_KCL
06 October 2016 20:12
RT @Ismalia_S: Some training even after uni! That's great to know #wenurses #gcschat https://twitter.com/JFr4ser/status/784108422321082369
@Bartontd
06 October 2016 20:12
RT @SueWoodward_KCL: @Marie_Batey @Ismalia_S you and me both! Interesting that nothing much has changed in thAt time #GCSchat #wenurses
@keeling_michael
06 October 2016 20:12
@Ismalia_S @Marie_Batey it was def a while ago!! #wenurses
@Ismalia_S
06 October 2016 20:12
I can see it has been a long time for some of you, so Q2 - How confident do you feel doing it? #wenurses #gcschat
@WeNurses
06 October 2016 20:12
RT @keeling_michael: @Ismalia_S worked within neurosurgery and neuro icu, used it daily for a long time, not been updated since.. #wenurses
@keeling_michael
06 October 2016 20:13
RT @Ismalia_S: Has anyone else experience the same? #wenurses #gcschat https://twitter.com/matthewvanloo/status/784108559629946881
@WeNurses
06 October 2016 20:13
How confident to you feel about GCS ? #WeNurses https://twitter.com/Ismalia_S/status/784109117971505152
@keeling_michael
06 October 2016 20:13
RT @AgencyNurse: Yes i am having the same thought .. was taught but never had a refresh #Wenurses https://twitter.com/Marie_Batey/status/784108441283522560
@SueWoodward_KCL
06 October 2016 20:13
@Ismalia_S @JFr4ser did anyone teach different techniques or did you find it standardised? #gcschat #WeNurses
@Marie_Batey
06 October 2016 20:13
The inside of people's heads are the same (& their nervous system) but has practice moved on? @SueWoodward_KCL @Ismalia_S #WeNurses #gcschat
@Marie_Batey
06 October 2016 20:14
RT @Ismalia_S: @keeling_michael and @Marie_Batey you are on the same team! #wenurses #gcschat https://t.co/fH7w0m69Ml
@MandyHollis3
06 October 2016 20:14
RT @WeNurses: No problem - there are some details here >> http://www.wecommunities.org/tweet-chats/chat-details/2861 #Wenurses https://twitter.com/PUNCdenise16/status/784108306554052608
@Bartontd
06 October 2016 20:14
42 Years of the GCS #wenurses http://ln.is/www.gla.ac.uk/news/a/u56Oi
@Jo_Thomas67
06 October 2016 20:14
This is a great resource about GCS #WeNurses https://t.co/muGsuT1N5S
@matthewvanloo
06 October 2016 20:14
@Ismalia_S fully comfortable due to a decade in a major trauma centre. If I worked in a less acute area, then May be different #WeNurses
@keeling_michael
06 October 2016 20:14
RT @AgencyNurse: Was the teaching different ? Or the same sort of stuff ? #WeNurses https://t.co/gi48BYchOn
@AgencyNurse
06 October 2016 20:14
mmmmm - not very ! But i use it so rarely now #WeNurses However it is a skill that is needed at times where i wo… https://t.co/v4SgrF9wDq
@Ismalia_S
06 October 2016 20:14
@Marie_Batey @SueWoodward_KCL Teasdale made some recommendations in 2014 but not all trusts have followed them #wenurses #gcschat
@WeNurses
06 October 2016 20:15
Thank you #WeNurses #EBP https://t.co/5B0DAOekT6
@Luvphotosme
06 October 2016 20:15
#wenurses Hi sorry for late arrival. V interested in GCS
@WeNurses
06 October 2016 20:15
RT @Bartontd: 42 Years of the GCS #wenurses https://t.co/3GxQgdXy05
@matthewvanloo
06 October 2016 20:15
@SueWoodward_KCL @Ismalia_S @JFr4ser I was taught in a neurosurgery ward, they had a different understanding to most other areas #WeNurses
@JFr4ser
06 October 2016 20:15
@AgencyNurse @Ismalia_S Same I think. Over years painful stimuli has changed.Did ICP monitoring for cerebral oedema, reinforced it #wenurses
@WeNurses
06 October 2016 20:15
A good question Marie #WeNurses https://t.co/KhMyX72Mik
@keeling_michael
06 October 2016 20:16
@Ismalia_S @matthewvanloo there was some training introduced to try to standardise practice, and interpretation of motor scores #wenurses
@SueWoodward_KCL
06 October 2016 20:16
RT @Ismalia_S: @Marie_Batey @SueWoodward_KCL Teasdale made some recommendations in 2014 but not all trusts have followed them #wenurses #gc…
@keeling_michael
06 October 2016 20:16
RT @Ismalia_S: I can see it has been a long time for some of you, so Q2 - How confident do you feel doing it? #wenurses #gcschat
@falls_blackpool
06 October 2016 20:16
RT @Ismalia_S: So .. Q1 - when was the last time you were taught about how to perform a GCS assessment? #wenurses #Gcschat
@AgencyNurse
06 October 2016 20:16
So small changes but a refresh of skills #WeNurses https://t.co/OMpvjEJY7v
@Ismalia_S
06 October 2016 20:16
Good point. We might not need it frequently in our areas but when it's needed we need to be doing it well #wenurses… https://t.co/T2SnTMDjjr
@AgencyNurse
06 October 2016 20:16
RT @Ismalia_S: Good point. We might not need it frequently in our areas but when it's needed we need to be doing it well #wenurses #gcschat…
@AgencyNurse
06 October 2016 20:17
@Ismalia_S yes indeed - i feel an update coming on !! #WeNurses
@Ismalia_S
06 October 2016 20:17
@Luvphotosme still on time #wenurses #gcschat
@MandyHollis3
06 October 2016 20:17
@Ismalia_S Formally many yrs ago but when developing electronic records a by product was a refresher about 4 yrs ago #WeNurses #gcschat
@nadasj89
06 October 2016 20:17
@WeNurses @Ismalia_S depends on the case, some times it's easily applicable other times the scoring can be confusing #WeNurses
@Marie_Batey
06 October 2016 20:17
I'm not 'hands on clinical' now BUT I'd definitely ask for help if I was to return to direct care. @Ismalia_S #WeNurses #gcschat
@WeNurses
06 October 2016 20:17
#WeNurses >> https://twitter.com/claire_rudwick/status/784109568372662276
@VickyPdns
06 October 2016 20:17
RT @Ismalia_S: @Marie_Batey @SueWoodward_KCL Teasdale made some recommendations in 2014 but not all trusts have followed them #wenurses #gc…
@Marie_Batey
06 October 2016 20:17
RT @Ismalia_S: I can see it has been a long time for some of you, so Q2 - How confident do you feel doing it? #wenurses #gcschat
@DaveAshton_
06 October 2016 20:17
RT @Bartontd: 42 Years of the GCS #wenurses http://ln.is/www.gla.ac.uk/news/a/u56Oi
@Marie_Batey
06 October 2016 20:17
RT @WeNurses: How confident to you feel about GCS ? #WeNurses https://twitter.com/Ismalia_S/status/784109117971505152
@Ismalia_S
06 October 2016 20:17
@keeling_michael @matthewvanloo and how did that go? #WeNurses #gcschat
@WeNurses
06 October 2016 20:17
#WeNurses - thats good to hear https://twitter.com/chrisreedy5/status/784109338130542592
@BCUSALTSOC
06 October 2016 20:17
We are lurking around #wenurses GCS chat! As #slt2b we're taught about GCS in relation to TBI & head injury! Interested to read nurses views
@keeling_michael
06 October 2016 20:18
@Ismalia_S I feel still feel confident in my practice, although do not use it as frequently now... #wenurses
@matthewvanloo
06 October 2016 20:18
@Marie_Batey @SueWoodward_KCL @Ismalia_S since 1979 CT & ICP monitoring more common, but not replacements for clinical assessment #WeNurses
@Ismalia_S
06 October 2016 20:18
@AgencyNurse I think a refresher of skills is always important in a lot of the things #wenurses #gcschat
@WeNurses
06 October 2016 20:18
RT @Ismalia_S: @Marie_Batey @SueWoodward_KCL Teasdale made some recommendations in 2014 but not all trusts have followed them #wenurses #gc…
@sprod_karen
06 October 2016 20:18
@SueWoodward_KCL @obu_nurses not yet. Week 2 coming to a close. Keen to learn #WeNurses #GCSchat
@HealthUKTD
06 October 2016 20:18
RT @matthewvanloo: @Ismalia_S was first taught as a first yr student nurse. Used it regularly since. #WeNurses
@HealthUKTD
06 October 2016 20:18
RT @Ismalia_S: So .. Q1 - when was the last time you were taught about how to perform a GCS assessment? #wenurses #Gcschat
@HealthUKTD
06 October 2016 20:18
RT @Ismalia_S: I can see it has been a long time for some of you, so Q2 - How confident do you feel doing it? #wenurses #gcschat
@WeNurses
06 October 2016 20:18
Latecomers always welcome #WeNurses https://t.co/vJjV2EZGIX
@Ismalia_S
06 October 2016 20:19
For those that use it daily or don't Q3 - When you report and document your findings, do you use the score and/or the scale? #wenurses
@MandyHollis3
06 October 2016 20:19
@Ismalia_S reasonably confident provided I had the proforma in front of me #WeNurses #gcschat
@matthewvanloo
06 October 2016 20:19
@keeling_michael @Ismalia_S interpretation of score is the biggest factor in consistency - especially the middle ground M score #WeNurses
@falls_blackpool
06 October 2016 20:19
RT @Marie_Batey: @Ismalia_S It's interesting to reflect on the fact that I was taught it once though... and never since. #WeNurses #gcschat
@Ismalia_S
06 October 2016 20:19
@Marie_Batey I always found it helpful to ask for 2nd opinion when scores differ #wenurses #gcschat
@keeling_michael
06 October 2016 20:19
@Ismalia_S @SueWoodward_KCL @NeuroNurseForum think that if not in area where it is used frequently very difficult to maintain.. #wenurses
@creator9988
06 October 2016 20:19
@WeNurses @Ismalia_S I have little confusion in determining some scores ... #WeNurses
@WeNurses
06 October 2016 20:19
RT @Ismalia_S: Good point. We might not need it frequently in our areas but when it's needed we need to be doing it well #wenurses #gcschat…
@SueWoodward_KCL
06 October 2016 20:20
RT @sprod_karen: @SueWoodward_KCL @obu_nurses not yet. Week 2 coming to a close. Keen to learn #WeNurses #GCSchat
@cherylwilson2
06 October 2016 20:20
Also late hello #WeNurses https://t.co/l7EioUvTIT
@keeling_michael
06 October 2016 20:20
RT @Ismalia_S: @keeling_michael @matthewvanloo and how did that go? #WeNurses #gcschat
@Ismalia_S
06 October 2016 20:20
@keeling_michael how about those thrombolysis calls? #wenurses #gcschat
@Luvphotosme
06 October 2016 20:20
#wenurses Thank you.
@MandyHollis3
06 October 2016 20:20
@WeNurses @Luvphotosme that's good as I'm late too but great topic #gcschat #WeNurses
@Ismalia_S
06 October 2016 20:20
@SueWoodward_KCL is a great teacher :) #wenurses #gcschat https://twitter.com/BCUSALTSOC/status/784110464594747392
@JFr4ser
06 October 2016 20:20
@Ismalia_S both. Score and breakdown of each EVM? Have i understood the question right? #wenurses
@matthewvanloo
06 October 2016 20:21
@Ismalia_S @AgencyNurse is AVPU more appropriate in areas where its not commonly used? Recognise deteriorating patient & escalate #WeNurses
@WeNurses
06 October 2016 20:21
Interesting point - can anyone help #WeNurses https://t.co/1TfoHv7lId
@Ismalia_S
06 October 2016 20:21
@keeling_michael @SueWoodward_KCL @NeuroNurseForum yes, agree... so that's why a refresher is usually good #wenurses #gcschat
@Marie_Batey
06 October 2016 20:21
Would be interested to know if currently this is common when there is a GCS query (to ask for a 2nd checker) @Ismalia_S #WeNurses #gcschat
@Ismalia_S
06 October 2016 20:21
@WeNurses @SueWoodward_KCL @NeuroNurseForum #gcschat #WeNurses https://t.co/FvhWd0tgDS
@AgencyNurse
06 October 2016 20:21
RT @Marie_Batey: I'm not 'hands on clinical' now BUT I'd definitely ask for help if I was to return to direct care. @Ismalia_S #WeNurses #g…
@keeling_michael
06 October 2016 20:21
@Ismalia_S @matthewvanloo interesting variations interpretation of assessment.. Def need for training/education... #wenurses n
@Luvphotosme
06 October 2016 20:22
#wenurses use GCS on daily basis in ITU.
@SueWoodward_KCL
06 October 2016 20:22
@Ismalia_S @BCUSALTSOC Too kind! #GCSchat #wenurses
@Bartontd
06 October 2016 20:22
RT @cherylwilson2: Also late hello #WeNurses https://twitter.com/wenurses/status/784110674372857856
@Ismalia_S
06 October 2016 20:22
@matthewvanloo @keeling_michael uuhh we will get down to that soon #gcschat #WeNurses
@WeNurses
06 October 2016 20:22
Nice to have you lurking #WeNurses https://twitter.com/BCUSALTSOC/status/784110464594747392
@sprod_karen
06 October 2016 20:22
@KathyHalson @WeNurses Hi Kathy .I'm on number 3 - still getting to grips with tweetchats. Very informative though. #gcschat #WeNurses
@keeling_michael
06 October 2016 20:22
RT @Ismalia_S: @matthewvanloo @keeling_michael uuhh we will get down to that soon #gcschat #WeNurses
@matthewvanloo
06 October 2016 20:22
@JFr4ser @SueWoodward_KCL @Ismalia_S neuro placed much more emphasis on understanding true score of patient, not 'GCS is about 10' #WeNurses
@WeNurses
06 October 2016 20:23
A good question #Wenurses https://twitter.com/Ismalia_S/status/784110731440652288
@Ismalia_S
06 October 2016 20:23
@creator9988 @WeNurses which ones for example? @SueWoodward_KCL @NeuroNurseForum #WeNurses #gcschat
@Bartontd
06 October 2016 20:23
RT @Luvphotosme: #wenurses use GCS on daily basis in ITU.
@keeling_michael
06 October 2016 20:23
RT @Ismalia_S: @keeling_michael how about those thrombolysis calls? #wenurses #gcschat
@RoyLilley
06 October 2016 20:23
RT @WeNurses: Interesting point - can anyone help #WeNurses https://t.co/1TfoHv7lId
@JFr4ser
06 October 2016 20:23
@matthewvanloo @Ismalia_S @AgencyNurse In early days of EWS introduction Glasgow scoring was both. Advice to switch if V or less #wenurses
@AgencyNurse
06 October 2016 20:23
A good point #WeNurses https://t.co/AJTsp4AzbD
@Jamie_Mullard
06 October 2016 20:23
RT @BCUSALTSOC: We are lurking around #wenurses GCS chat! As #slt2b we're taught about GCS in relation to TBI & head injury! Interested to…
@Ismalia_S
06 October 2016 20:24
@Marie_Batey I would like to think and hope there is! #wenurses #gcschat
@cherylwilson2
06 October 2016 20:24
RT @WeNurses: A good question #Wenurses https://twitter.com/Ismalia_S/status/784110731440652288
@SueWoodward_KCL
06 October 2016 20:24
@Marie_Batey @Ismalia_S worth asking, but always Trust your own judgement #Wenurses #GCSchat
@WeNurses
06 October 2016 20:24
@MandyHollis3 @Luvphotosme welcome Mandy #WeNurses
@SueWoodward_KCL
06 October 2016 20:24
RT @Ismalia_S: @WeNurses @SueWoodward_KCL @NeuroNurseForum #gcschat #WeNurses https://twitter.com/Ismalia_S/status/784110731440652288
@Ismalia_S
06 October 2016 20:24
and standardisation #wenurses #gcschat https://twitter.com/keeling_michael/status/784111450298191872
@keeling_michael
06 October 2016 20:24
@Ismalia_S yes, can is used but NIHSS more useful.. #wenurses
@Luvphotosme
06 October 2016 20:24
#wenurses re q3 - score 15/15 plus pupil reaction/size
@AgencyNurse
06 October 2016 20:24
I have in the past when i have not been confident #WeNurses https://twitter.com/Marie_Batey/status/784111413417607168
@keeling_michael
06 October 2016 20:24
RT @Ismalia_S: @keeling_michael @SueWoodward_KCL @NeuroNurseForum yes, agree... so that's why a refresher is usually good #wenurses #gcschat
@falls_blackpool
06 October 2016 20:25
@SueWoodward_KCL @Ismalia_S http://www.glasgowcomascale.org/ fab website what R your thoughts about the training video? ?? #GCSchat #wenurses
@matthewvanloo
06 October 2016 20:25
@JFr4ser @Ismalia_S same here always report its components #WeNurses
@WeNurses
06 October 2016 20:25
RT @Luvphotosme: #wenurses use GCS on daily basis in ITU.
@SueWoodward_KCL
06 October 2016 20:25
RT @Ismalia_S: and standardisation #wenurses #gcschat https://twitter.com/keeling_michael/status/784111450298191872
@keeling_michael
06 October 2016 20:25
@Ismalia_S @SueWoodward_KCL @NeuroNurseForum would help reduce inter user variability perhaps.. #wenurses
@Ismalia_S
06 October 2016 20:25
RT @SueWoodward_KCL: @Marie_Batey @Ismalia_S worth asking, but always Trust your own judgement #Wenurses #GCSchat
@keeling_michael
06 October 2016 20:25
RT @Ismalia_S: and standardisation #wenurses #gcschat https://twitter.com/keeling_michael/status/784111450298191872
@AgencyNurse
06 October 2016 20:25
That sounds interesting - please explain more #WeNurses https://twitter.com/matthewvanloo/status/784111656523722752
@keeling_michael
06 October 2016 20:26
RT @AgencyNurse: A good point #WeNurses https://twitter.com/matthewvanloo/status/784110762906247169
@Bartontd
06 October 2016 20:26
Tunnel Vision - look up - assessment tools are simply tools - lets talk about Clinical Decision Making with all that implies #wenurses
@Ismalia_S
06 October 2016 20:26
You have made my day! :) #wenurses #gcschat https://twitter.com/matthewvanloo/status/784112275833651200
@PUNC_Kristi
06 October 2016 20:26
@michellejbw @PUNC_KOHarrow @puncmandyh16 @Puncloisford16 This would be great to get involved with ?? #Wenurses… https://twitter.com/i/web/status/784112606701379588
@WeNurses
06 October 2016 20:26
A good point Dave #WeNurses https://twitter.com/Bartontd/status/784112542037708800
@SueWoodward_KCL
06 October 2016 20:26
@Ismalia_S @keeling_michael @matthewvanloo important to be consistent within a unit #GCSchat #WeNurses for inter-rather reliability
@ShakesCuthbert
06 October 2016 20:26
RT @Luvphotosme: #wenurses use GCS on daily basis in ITU.
@MisterHreben
06 October 2016 20:26
@Marie_Batey @Ismalia_S I often find it is far too subjective. #WeNurses
@AgencyNurse
06 October 2016 20:26
Are we coming back to clinical judgement #WeNurses https://t.co/AccE5R2gwQ
@SueWoodward_KCL
06 October 2016 20:27
RT @Ismalia_S: You have made my day! :) #wenurses #gcschat https://twitter.com/matthewvanloo/status/784112275833651200
@Jamie_Mullard
06 October 2016 20:27
@keeling_michael @Ismalia_S my final SLT placement is in adult stroke, I was not aware of this scale thank you! #wenurses #slt2b
@falls_blackpool
06 October 2016 20:27
RT @BCUSALTSOC: We are lurking around #wenurses GCS chat! As #slt2b we're taught about GCS in relation to TBI & head injury! Interested to…
@zoerose70
06 October 2016 20:27
You need to feel confident that you are competent the outcome of this assessment can change treatment and care planning#GCSchat #wenurses
@Ismalia_S
06 October 2016 20:27
It's always best to use the scale E, V and M. rather than the score (eg. 14/15) #wenurses #gcschat https://t.co/q7ux5rFRY2
@falls_blackpool
06 October 2016 20:27
RT @Ismalia_S: I can see it has been a long time for some of you, so Q2 - How confident do you feel doing it? #wenurses #gcschat
@WeNurses
06 October 2016 20:27
Good point #Wenurses https://t.co/8OoAhW0Mua
@creator9988
06 October 2016 20:27
@Ismalia_S @WeNurses @SueWoodward_KCL @NeuroNurseForum The confusion In motor response score .. #WeNurses
@Ismalia_S
06 October 2016 20:27
RT @SueWoodward_KCL: @Ismalia_S @keeling_michael @matthewvanloo important to be consistent within a unit #GCSchat #WeNurses for inter-rathe…
@AgencyNurse
06 October 2016 20:27
RT @Ismalia_S: It's always best to use the scale E, V and M. rather than the score (eg. 14/15) #wenurses #gcschat https://t.co/q7ux5rFRY2
@Bartontd
06 October 2016 20:27
Let your varied assessment tools guide your practice - not confine your professional judgement. #clinical #decision #making #wenurses
@SueWoodward_KCL
06 October 2016 20:27
@Ismalia_S definitely should use components, score relatively meaningless #gcschat #wenurses
@keeling_michael
06 October 2016 20:28
RT @WeNurses: A good question #Wenurses https://twitter.com/Ismalia_S/status/784110731440652288
@ShakesCuthbert
06 October 2016 20:28
RT @Ismalia_S: Good point. We might not need it frequently in our areas but when it's needed we need to be doing it well #wenurses #gcschat…
@SueWoodward_KCL
06 October 2016 20:28
RT @Ismalia_S: It's always best to use the scale E, V and M. rather than the score (eg. 14/15) #wenurses #gcschat https://t.co/q7ux5rFRY2
@NaomiRomrig81
06 October 2016 20:28
@Bartontd @WeNurses as STN we are being taught to discuss patients GCS during handover to confirm each Nurses interpretation #WeNurses
@Ismalia_S
06 October 2016 20:28
RT @SueWoodward_KCL: @Ismalia_S definitely should use components, score relatively meaningless #gcschat #wenurses
@cherylwilson2
06 October 2016 20:28
@Bartontd ??say this daily to my #nursing #team don't forget your #clinical #judgement #wenurses
@AgencyNurse
06 October 2016 20:28
This sounds like good practice #Wenurses https://t.co/82oUaZiNyh
@cherylwilson2
06 October 2016 20:29
@AgencyNurse @Bartontd snap #wenurses
@Ismalia_S
06 October 2016 20:29
.the biggest question (Q4) What are the differences between peripherally and centrally painful stimuli? #wenurses #gcschat @SueWoodward_KCL
@keeling_michael
06 October 2016 20:29
RT @Ismalia_S: @Marie_Batey I always found it helpful to ask for 2nd opinion when scores differ #wenurses #gcschat
@nadasj89
06 October 2016 20:29
@Ismalia_S @AgencyNurse how about both ? #WeNurses
@AgencyNurse
06 October 2016 20:29
I said this three times today !!! #WeNurses https://twitter.com/cherylwilson2/status/784113192360435713
@keeling_michael
06 October 2016 20:30
RT @Ismalia_S: @Marie_Batey I would like to think and hope there is! #wenurses #gcschat
@Marie_Batey
06 October 2016 20:30
So, what steps do you take to get your clinical assurance? Must be pivotal to safe care in your role @MisterHreben @Ismalia_S #WeNurses
@everything_teal
06 October 2016 20:30
#WeNurses Knowing your body and what’s normal for you will help you notice potential symptoms of #ovariancancer. https://t.co/6kJi6dxoUj
@Bartontd
06 October 2016 20:30
RT @cherylwilson2: @Bartontd ??say this daily to my #nursing #team don't forget your #clinical #judgement #wenurses
@BCUSALTSOC
06 October 2016 20:30
RT @AgencyNurse: This sounds like good practice #Wenurses https://twitter.com/NaomiFleming81/status/784113106742022145
@cherylwilson2
06 October 2016 20:30
RT @Ismalia_S: .the biggest question (Q4) What are the differences between peripherally and centrally painful stimuli? #wenurses #gcschat @…
@WeNurses
06 October 2016 20:30
Great question #WeNurses https://twitter.com/Ismalia_S/status/784113413731540992
@AgencyNurse
06 October 2016 20:30
RT @Ismalia_S: .the biggest question (Q4) What are the differences between peripherally and centrally painful stimuli? #wenurses #gcschat @…
@BCUSALTSOC
06 October 2016 20:30
RT @Ismalia_S: It's always best to use the scale E, V and M. rather than the score (eg. 14/15) #wenurses #gcschat https://twitter.com/AgencyNurse/status/784112458382319616
@SueWoodward_KCL
06 October 2016 20:31
Score only tells anything if 3 (no response) or 15(no deficits) #GCSchat #wenurses
@matthewvanloo
06 October 2016 20:31
@NaomiFleming81 @Bartontd @WeNurses even better - both nurses to assess patients GCS together to ensure both shifts are the same #WeNurses
@Ismalia_S
06 October 2016 20:31
RT @Ismalia_S: .the biggest question (Q4) What are the differences between peripherally and centrally painful stimuli? #wenurses #gcschat @…
@cherylwilson2
06 October 2016 20:31
RT @WeNurses: Great question #WeNurses https://twitter.com/Ismalia_S/status/784113413731540992
@zoerose70
06 October 2016 20:31
RT @WeNurses: Great question #WeNurses https://twitter.com/Ismalia_S/status/784113413731540992
@PUNC_Kristi
06 October 2016 20:31
I hope this helps people who are new to twitter, like me. #WeNurses #NS4303 #plymouthuniversity https://twitter.com/wenurses/status/780834862601211904
@NaomiRomrig81
06 October 2016 20:31
@AgencyNurse @Bartontd @WeNurses every tool is open to interpretation. I like this is ensures accountability and avoids delays #WeNurses
@BCUSALTSOC
06 October 2016 20:31
RT @SueWoodward_KCL: Score only tells anything if 3 (no response) or 15(no deficits) #GCSchat #wenurses
@keeling_michael
06 October 2016 20:32
@Ismalia_S a very comprehensive stroke assessment tool, plenty of online info & training assessment #wenurses :-)
@keeling_michael
06 October 2016 20:32
RT @SueWoodward_KCL: @Ismalia_S @keeling_michael @matthewvanloo important to be consistent within a unit #GCSchat #WeNurses for inter-rathe…
@HealthUKTD
06 October 2016 20:32
RT @Luvphotosme: #wenurses use GCS on daily basis in ITU.
@HealthUKTD
06 October 2016 20:32
RT @Ismalia_S: Good point. We might not need it frequently in our areas but when it's needed we need to be doing it well #wenurses #gcschat…
@Marie_Batey
06 October 2016 20:32
RT @Ismalia_S: .the biggest question (Q4) What are the differences between peripherally and centrally painful stimuli? #wenurses #gcschat @…
@AgencyNurse
06 October 2016 20:33
@NaomiFleming81 @Bartontd @WeNurses yes & sometimes even though tool tells us one thing our clinical judgement may say different #WeNurses
@Marie_Batey
06 October 2016 20:33
RT @SueWoodward_KCL: @Ismalia_S definitely should use components, score relatively meaningless #gcschat #wenurses
@Marie_Batey
06 October 2016 20:33
RT @Ismalia_S: It's always best to use the scale E, V and M. rather than the score (eg. 14/15) #wenurses #gcschat https://t.co/q7ux5rFRY2
@SueWoodward_KCL
06 October 2016 20:33
Regardless of stimulus applied, must make sure this is sufficient and not under stimulate #GCSchat #wenurses
@keeling_michael
06 October 2016 20:33
@SueWoodward_KCL @Ismalia_S @matthewvanloo such an important assessment, esp when referrals from other units.. #wenurses
@WeNurses
06 October 2016 20:33
RT @SueWoodward_KCL: Regardless of stimulus applied, must make sure this is sufficient and not under stimulate #GCSchat #wenurses
@Ismalia_S
06 October 2016 20:33
RT @SueWoodward_KCL: Score only tells anything if 3 (no response) or 15(no deficits) #GCSchat #wenurses
@nadasj89
06 October 2016 20:34
@WeNurses @Ismalia_S central can be found only if the brain response to pain while peripheral can result from a reflex #WeNurses
@keeling_michael
06 October 2016 20:34
RT @SueWoodward_KCL: Regardless of stimulus applied, must make sure this is sufficient and not under stimulate #GCSchat #wenurses
@JFr4ser
06 October 2016 20:34
@AgencyNurse @cherylwilson2 @Bartontd Although my understanding GCS very robust for sensitivity so can be relied upon? #wenurses
@NaomiRomrig81
06 October 2016 20:35
@AgencyNurse @Bartontd @WeNurses We have the advantage of learning best practice out of 'reality' what are the barrier's? #WeNurses
@keeling_michael
06 October 2016 20:35
@SueWoodward_KCL how do you judge over/under stimulation? #WeNurses
@JFr4ser
06 October 2016 20:35
@SueWoodward_KCL ahhh, my loud voice comes in very handy for this ?? #wenurses
@Ismalia_S
06 October 2016 20:36
@Nanoza_sj @WeNurses centrally applied stimuli needs to be directed to the core of the CNS - a cranial nerve #wenurses #gcschat
@AgencyNurse
06 October 2016 20:36
Im glad you asked this .... i would like to know too #WeNurses https://twitter.com/keeling_michael/status/784114935345319936
@WeNurses
06 October 2016 20:36
Thanks Ismalia #WeNurses https://twitter.com/Ismalia_S/status/784115066148904960
@keeling_michael
06 October 2016 20:37
RT @WeNurses: Great question #WeNurses https://twitter.com/Ismalia_S/status/784113413731540992
@cherylwilson2
06 October 2016 20:37
RT @Ismalia_S: @Nanoza_sj @WeNurses centrally applied stimuli needs to be directed to the core of the CNS - a cranial nerve #wenurses #gcsc…
@cherylwilson2
06 October 2016 20:37
RT @WeNurses: Thanks Ismalia #WeNurses https://twitter.com/Ismalia_S/status/784115066148904960
@keeling_michael
06 October 2016 20:37
RT @Ismalia_S: @Nanoza_sj @WeNurses centrally applied stimuli needs to be directed to the core of the CNS - a cranial nerve #wenurses #gcsc…
@nadasj89
06 October 2016 20:37
RT @Ismalia_S: @Nanoza_sj @WeNurses centrally applied stimuli needs to be directed to the core of the CNS - a cranial nerve #wenurses #gcsc…
@SueWoodward_KCL
06 October 2016 20:37
RT @Ismalia_S: @Nanoza_sj @WeNurses centrally applied stimuli needs to be directed to the core of the CNS - a cranial nerve #wenurses #gcsc…
@Marie_Batey
06 October 2016 20:37
Why don't 'we' do a TwitterChat about 'clinical judgement'? @AgencyNurse #WeNurses #gcschat Off topic, I know...
@JFr4ser
06 October 2016 20:37
@keeling_michael @SueWoodward_KCL Experience. Many inexperienced nurses in GCS are quiet and unwilling to apply to much pain #wenurses
@BCUSALTSOC
06 October 2016 20:37
Another @MyBCU student taking part in tonight's #wenurses GCS chat! Interesting chat, nice to collaborate with memb… https://twitter.com/i/web/status/784115502071373824
@vsc1970
06 October 2016 20:38
RT @Bartontd: 42 Years of the GCS #wenurses https://t.co/3GxQgdXy05
@Ismalia_S
06 October 2016 20:38
apart from clinical judgement (Q5) Is it only the GCS that matters when assessing for neurological deterioration? #wenurses #gcschat
@keeling_michael
06 October 2016 20:38
@Ismalia_S @Nanoza_sj @WeNurses peripheral stimulus only for eye opening? #wenurses
@keeling_michael
06 October 2016 20:38
RT @AgencyNurse: Im glad you asked this .... i would like to know too #WeNurses https://t.co/D3wwKHbXqV
@AgencyNurse
06 October 2016 20:38
oooh yes !!!!!!! Good idea ..... fancy helping Marie ?? #WeNurses https://t.co/rxbiC4gE1v
@MandyHollis3
06 October 2016 20:38
RT @Ismalia_S: apart from clinical judgement (Q5) Is it only the GCS that matters when assessing for neurological deterioration? #wenurses…
@mary_titchener
06 October 2016 20:38
RT @Marie_Batey: Why don't 'we' do a TwitterChat about 'clinical judgement'? @AgencyNurse #WeNurses #gcschat Off topic, I know...
@MisterHreben
06 October 2016 20:38
@Marie_Batey @Ismalia_S it is. Often I'll escalate as that is what I am presented with. Better safe than sorry. #WeNurses
@JFr4ser
06 October 2016 20:38
@keeling_michael @SueWoodward_KCL plus they must wake the patient up first and assess at that point. Often don't #wenurses
@NaomiRomrig81
06 October 2016 20:39
@nursescott2 @Ismalia_S @Bartontd @WeNurses just pulling you in here. Your lecture today is reaching the net #wenurses
@cherylwilson2
06 October 2016 20:39
RT @Ismalia_S: apart from clinical judgement (Q5) Is it only the GCS that matters when assessing for neurological deterioration? #wenurses…
@Marie_Batey
06 October 2016 20:39
Definitely! @AgencyNurse #Let'sDoIt #WeNurses :)
@mary_titchener
06 October 2016 20:39
RT @AgencyNurse: oooh yes !!!!!!! Good idea ..... fancy helping Marie ?? #WeNurses https://t.co/rxbiC4gE1v
@AgencyNurse
06 October 2016 20:39
Good question #WeNurses https://t.co/44y8uzQoWa
@fussy1958
06 October 2016 20:39
RT @Ismalia_S: and standardisation #wenurses #gcschat https://t.co/5WEh5TkbY0
@nadasj89
06 October 2016 20:39
@keeling_michael @Ismalia_S @WeNurses what about the limbs ? #WeNurses
@Ismalia_S
06 October 2016 20:39
@keeling_michael @Nanoza_sj @WeNurses Yes, peripherally applied stimuli for eye opening with exceptions #wenurses #gcschat
@AgencyNurse
06 October 2016 20:40
@Marie_Batey cool - do i still have your email ? Think it may have changed .. can you DM me it please :D #WeNurses
@fussy1958
06 October 2016 20:40
Think should always feel comfortable to get a second checker #wenurses https://twitter.com/agencynurse/status/784112198876598272
@AgencyNurse
06 October 2016 20:40
@Marie_Batey love how one chat can lead to another #WeNurses
@nadasj89
06 October 2016 20:40
@AgencyNurse @Marie_Batey this will definitely be insightful #WeNurses
@AgencyNurse
06 October 2016 20:40
RT @fussy1958: Think should always feel comfortable to get a second checker #wenurses https://twitter.com/agencynurse/status/784112198876598272
@matthewvanloo
06 October 2016 20:40
@Ismalia_S no. Assessment of deterioration is multidimensional. From pupil assessment to blood sugar level. #WeNurses
@AgencyNurse
06 October 2016 20:40
@fussy1958 I agree Kay #Wenurses
@dtbarron
06 October 2016 20:40
Would also be useful to have chat on the recording of clinical judgement i.e. How you got there #wenurses @AgencyNurse @Marie_Batey
@Marie_Batey
06 October 2016 20:40
Will do! @AgencyNurse #Excited #WeNurses
@keeling_michael
06 October 2016 20:40
@JFr4ser @SueWoodward_KCL agree experience is very helpful, and nurses do not always want to apply 'to much' pain.. #wenurses
@WeNurses
06 October 2016 20:41
RT @matthewvanloo: @Ismalia_S no. Assessment of deterioration is multidimensional. From pupil assessment to blood sugar level. #WeNurses
@VickyPdns
06 October 2016 20:41
RT @Ismalia_S: apart from clinical judgement (Q5) Is it only the GCS that matters when assessing for neurological deterioration? #wenurses…
@Ismalia_S
06 October 2016 20:41
Limb assessment are definitely a component of your neurological observations, like pupil assessment #wenurses… https://t.co/RI3CSDz4Pg
@AgencyNurse
06 October 2016 20:41
@dtbarron @Marie_Batey oooh we will be sure to include !!! #Wenurses
@sarah_janemad
06 October 2016 20:41
@JFr4ser @keeling_michael @SueWoodward_KCL I get them to do a trapezius squeeze on each other so they know how it feels & how hard #WeNurses
@everything_teal
06 October 2016 20:41
#WeNurses All women should know the signs and symptoms of #OvarianCancer. Get informed, and spread the word! https://t.co/3GKCy6ky60
@JFr4ser
06 October 2016 20:41
@Ismalia_S @Nanoza_sj @WeNurses Ooh ooh ooh to touch and feel.... Trapezius muscle works ?? #wenurses
@bertie_mack
06 October 2016 20:41
RT @everything_teal: #WeNurses All women should know the signs and symptoms of #OvarianCancer. Get informed, and spread the word! https://t…
@keeling_michael
06 October 2016 20:41
@JFr4ser @SueWoodward_KCL yes, not suddenly pounce at 2am with pain! #wenurses
@Ismalia_S
06 October 2016 20:42
RT @matthewvanloo: @Ismalia_S no. Assessment of deterioration is multidimensional. From pupil assessment to blood sugar level. #WeNurses
@nadasj89
06 October 2016 20:42
RT @Ismalia_S: Limb assessment are definitely a component of your neurological observations, like pupil assessment #wenurses #gcschat https…
@AgencyNurse
06 October 2016 20:42
@everything_teal Hi Thanks for your tweet but we are currently holding a discussion about GCS using #WeNurses
@nursescott2
06 October 2016 20:42
@NaomiFleming81 @AgencyNurse @Bartontd @WeNurses In my experience some staff will 'do obs' an A-E gives you that & more ! #WeNurses
@sarah_janemad
06 October 2016 20:42
@fussy1958 @AgencyNurse agree and there should be a Joint check at handover to reduce subjectivity error #WeNurses
@Marie_Batey
06 October 2016 20:42
Me too! @AgencyNurse ?? #WeNurses
@nadasj89
06 October 2016 20:42
RT @JFr4ser: @Ismalia_S @Nanoza_sj @WeNurses Ooh ooh ooh to touch and feel.... Trapezius muscle works ?? #wenurses
@dtbarron
06 October 2016 20:42
Easier to support staff if you know how they got to a decision, even if you would have done different @AgencyNurse @Marie_Batey #wenurses
@keeling_michael
06 October 2016 20:43
@sarah_janemad @JFr4ser @SueWoodward_KCL always used supra orbital stimulation... Had it done on myself... I localised & more!! #WeNurses
@fussy1958
06 October 2016 20:43
Seems s good idea #WeNurses builds competence and confidence https://t.co/vOWSjCUy0a
@WeNurses
06 October 2016 20:43
RT @JFr4ser: @Ismalia_S @Nanoza_sj @WeNurses Ooh ooh ooh to touch and feel.... Trapezius muscle works ?? #wenurses
@Ismalia_S
06 October 2016 20:43
Very good idea! They will know the difference between understimulate and overstimulate #wenurses #gcschat https://t.co/AaLvtzPsmz
@JFr4ser
06 October 2016 20:43
@sarah_janemad @keeling_michael @SueWoodward_KCL I will occasionally do it to my husband. Great for stopping snoring or ignoring #wenurses
@sarah_janemad
06 October 2016 20:43
@NaomiFleming81 @AgencyNurse @Bartontd agree - News scoring does not give the whole picture must be look listen feel approach #wenurses
@VickyPdns
06 October 2016 20:44
RT @Ismalia_S: Limb assessment are definitely a component of your neurological observations, like pupil assessment #wenurses #gcschat https…
@WeNurses
06 October 2016 20:44
RT @fussy1958: Seems s good idea #WeNurses builds competence and confidence https://t.co/vOWSjCUy0a
@Marie_Batey
06 October 2016 20:44
Do it with @AgencyNurse and I @dtbarron #WeNurses #DeadlyCombo :)
@AgencyNurse
06 October 2016 20:44
RT @Ismalia_S: Very good idea! They will know the difference between understimulate and overstimulate #wenurses #gcschat https://t.co/AaLvt…
@Ismalia_S
06 October 2016 20:44
Q6 - Which situations do you encounter in your practice that affect the way you perform the GCS assessment? #wenurses #gcschat
@WeNurses
06 October 2016 20:45
Interesting question #WeNurses https://twitter.com/Ismalia_S/status/784117195379007488
@NaomiRomrig81
06 October 2016 20:45
@AgencyNurse @Marie_Batey Do we use baseline is and assessments to report minor changes that indicate deterioration enough? #WeNurses
@AgencyNurse
06 October 2016 20:45
RT @WeNurses: Interesting question #WeNurses https://twitter.com/Ismalia_S/status/784117195379007488
@NaomiRomrig81
06 October 2016 20:45
RT @fussy1958: Seems s good idea #WeNurses builds competence and confidence https://twitter.com/naomifleming81/status/784113106742022145
@Ismalia_S
06 October 2016 20:45
@keeling_michael @sarah_janemad @JFr4ser @SueWoodward_KCL I use 1st trapezius (CN XI) . supraorbital (CN V) my 2nd option #wenurses #gcschat
@cherylwilson2
06 October 2016 20:46
RT @WeNurses: Interesting question #WeNurses https://twitter.com/Ismalia_S/status/784117195379007488
@Marie_Batey
06 October 2016 20:46
RT @dtbarron: Would also be useful to have chat on the recording of clinical judgement i.e. How you got there #wenurses @AgencyNurse @Marie…
@nadasj89
06 October 2016 20:46
RT @WeNurses: Interesting question #WeNurses https://t.co/G1dEzPrHcD
@WeNurses
06 October 2016 20:46
RT @Ismalia_S: @Nanoza_sj @WeNurses centrally applied stimuli needs to be directed to the core of the CNS - a cranial nerve #wenurses #gcsc…
@Ismalia_S
06 October 2016 20:46
@sarah_janemad @NaomiFleming81 @AgencyNurse @Bartontd with some other assessments: pupil, limb, vital signs, etc #wenurses #gcschat
@keeling_michael
06 October 2016 20:47
@Ismalia_S @sarah_janemad @JFr4ser @SueWoodward_KCL it helps, dif pts require dif amounts/level of stimulation to illicit response #WeNurses
@keeling_michael
06 October 2016 20:47
RT @Ismalia_S: Very good idea! They will know the difference between understimulate and overstimulate #wenurses #gcschat https://t.co/AaLvt…
@keeling_michael
06 October 2016 20:47
RT @fussy1958: Seems s good idea #WeNurses builds competence and confidence https://twitter.com/naomifleming81/status/784113106742022145
@WeNurses
06 October 2016 20:47
an excellent point #Wenurses https://twitter.com/keeling_michael/status/784117793625088000
@dtbarron
06 October 2016 20:47
@AgencyNurse @Marie_Batey Yep - I'm there ?? #WeNurses
@NaomiRomrig81
06 October 2016 20:47
RT @Ismalia_S: @sarah_janemad @NaomiFleming81 @AgencyNurse @Bartontd with some other assessments: pupil, limb, vital signs, etc #wenurses #…
@JFr4ser
06 October 2016 20:47
@Ismalia_S head injury when eye is swollen shut.... eeuuwwww I hate trauma #wenurses
@nursescott2
06 October 2016 20:47
@NaomiFleming81 @MisterHreben @Marie_Batey @Ismalia_S Ias a clinician making an assessment you should stand by it and act upon #WeNurses
@keeling_michael
06 October 2016 20:47
RT @WeNurses: Interesting question #WeNurses https://t.co/G1dEzPrHcD
@keeling_michael
06 October 2016 20:47
RT @Ismalia_S: Q6 - Which situations do you encounter in your practice that affect the way you perform the GCS assessment? #wenurses #gcsch…
@Ismalia_S
06 October 2016 20:48
@JFr4ser @sarah_janemad @keeling_michael @SueWoodward_KCL ahahha and I guess you don't understimulate #wenurses #gcschat
@Luvphotosme
06 October 2016 20:48
#wenurses. Sorry seem to have missed Q4&Q5. Q6 - use RASS for sedated pt and CAM ICU for all pts.
@HealthUKTD
06 October 2016 20:48
RT @Ismalia_S: @Nanoza_sj @WeNurses centrally applied stimuli needs to be directed to the core of the CNS - a cranial nerve #wenurses #gcsc…
@HealthUKTD
06 October 2016 20:48
RT @Ismalia_S: apart from clinical judgement (Q5) Is it only the GCS that matters when assessing for neurological deterioration? #wenurses…
@nursescott2
06 October 2016 20:48
@NaomiFleming81 @MisterHreben @Marie_Batey @Ismalia_S could you be 'talked out ' of a decision after a 2nd or 3rd opinion ? #WeNurses
@keeling_michael
06 October 2016 20:48
@Ismalia_S @sarah_janemad @JFr4ser @SueWoodward_KCL why that way round? #wenurses
@NaomiRomrig81
06 October 2016 20:49
@sarah_janemad @AgencyNurse @Bartontd even with my fresh eyes Visual speaks volumes ???? #WeNurses
@keeling_michael
06 October 2016 20:49
RT @WeNurses: an excellent point #Wenurses https://twitter.com/keeling_michael/status/784117793625088000
@keeling_michael
06 October 2016 20:49
RT @Ismalia_S: @JFr4ser @sarah_janemad @keeling_michael @SueWoodward_KCL ahahha and I guess you don't understimulate #wenurses #gcschat
@Marie_Batey
06 October 2016 20:49
@sarah_janemad @NaomiFleming81 @AgencyNurse @Bartontd Totally agree! Assessment involves deploying most of our senses, surely. #WeNurses
@Ismalia_S
06 October 2016 20:49
@JFr4ser how do you score then? what do you use? #gcschat #wenurses
@MisterHreben
06 October 2016 20:49
@nursescott2 @NaomiFleming81 @Marie_Batey @Ismalia_S My point exactly. Especially if I am triaging and deciding priority. #WeNurses
@WeNurses
06 October 2016 20:49
RT @Luvphotosme: #wenurses. Sorry seem to have missed Q4&Q5. Q6 - use RASS for sedated pt and CAM ICU for all pts.
@AgencyNurse
06 October 2016 20:49
Yes agree #WeNurses https://twitter.com/Marie_Batey/status/784118404554825729
@fussy1958
06 October 2016 20:50
@WeNurses @Ismalia_S environment, including the urgency of the situation, and others working with patient. #WeNurses
@Ismalia_S
06 October 2016 20:50
@Luvphotosme excuse me.. but what is RASS and CAM? #wenurses #gcschat
@keeling_michael
06 October 2016 20:50
RT @MisterHreben: @Marie_Batey @Ismalia_S it is. Often I'll escalate as that is what I am presented with. Better safe than sorry. #WeNurses
@WeNurses
06 October 2016 20:50
RT @fussy1958: @WeNurses @Ismalia_S environment, including the urgency of the situation, and others working with patient. #WeNurses
@SianP107
06 October 2016 20:50
#WeNurses#cypnurses. what about variations due to age (0-18yrs) disability (dementia, learning disabilities) etc?
@JFr4ser
06 October 2016 20:50
@Ismalia_S Chart has eye shut option #wenurses
@nadasj89
06 October 2016 20:51
RT @fussy1958: @WeNurses @Ismalia_S environment, including the urgency of the situation, and others working with patient. #WeNurses
@WeNurses
06 October 2016 20:51
This is a very good point > #Wenurses https://t.co/46HFAN0LfG
@jarvinator25
06 October 2016 20:52
@Ismalia_S GCS is only part of a full set of neurological observations including vital signs, pupils and limb strengths #wenurses #gcschat
@NaomiRomrig81
06 October 2016 20:52
@JFr4ser @nursescott2 @MisterHreben @Marie_Batey @Ismalia_S Do we involve the PT's family enough in assessment. They know The NORM #WeNurses
@JFr4ser
06 October 2016 20:52
@Marie_Batey @sarah_janemad @NaomiFleming81 @AgencyNurse @Bartontd All but taste i often say. No need to lick pts or fluids now #wenurses
@nadasj89
06 October 2016 20:52
@WeNurses @dormouse107 indeed I've always wondered how could this impact the scoring outcome? #WeNurses
@nadasj89
06 October 2016 20:52
RT @WeNurses: This is a very good point > #Wenurses https://t.co/46HFAN0LfG
@Ismalia_S
06 October 2016 20:53
@MisterHreben @nursescott2 @NaomiFleming81 @Marie_Batey (2/2) especially for those that do it everyday for a long time #wenurses #gcschat
@Marie_Batey
06 October 2016 20:53
Marvellous! @AgencyNurse @dtbarron #WeNurses
@Ismalia_S
06 October 2016 20:53
@JFr4ser very good! #WeNurses
@keeling_michael
06 October 2016 20:53
@JFr4ser @nursescott2 @NaomiFleming81 @MisterHreben @Marie_Batey @Ismalia_S it does change, as long as assessment is standardised #wenurses
@JFr4ser
06 October 2016 20:53
@NaomiFleming81 @nursescott2 @MisterHreben @Marie_Batey @Ismalia_S Have to cautious with that Assess then collateral. Less bias #wenurses
@ConnollyNursing
06 October 2016 20:54
Such a great comment from @Bartontd #wenurses tweetchat-easily transferrable to many clinical scenarios https://twitter.com/Bartontd/status/784112965591195648
@AgencyNurse
06 October 2016 20:54
RT @ConnollyNursing: Such a great comment from @Bartontd #wenurses tweetchat-easily transferrable to many clinical scenarios https://t.co/a…
@Ismalia_S
06 October 2016 20:54
@WeNurses you should always establish a baseline assessment (inc pt history) and report variations from your baseline #wenurses #gcschat
@DebDjh
06 October 2016 20:54
RT @Bartontd: 42 Years of the GCS #wenurses http://ln.is/www.gla.ac.uk/news/a/u56Oi
@keeling_michael
06 October 2016 20:55
@JFr4ser @Marie_Batey @sarah_janemad @NaomiFleming81 @AgencyNurse @Bartontd urgh! Thank goodness we have moved past taste tests! #wenurses
@WeNurses
06 October 2016 20:55
This is good advice #WeNurses https://twitter.com/Ismalia_S/status/784119722384224256
@fussy1958
06 October 2016 20:55
Look at your patient and observe them and any clinical data together #wenurses https://twitter.com/connollynursing/status/784119541802631168
@Marie_Batey
06 October 2016 20:55
@NaomiFleming81 @JFr4ser @nursescott2 @MisterHreben @Ismalia_S Exactly, wider perspectives are always helpful. #WeNurses #gcschat
@Ismalia_S
06 October 2016 20:55
Last question before we close (Q7) Who carries out a GCS assessment during handover? #wenurses #gcschat
@keeling_michael
06 October 2016 20:55
RT @fussy1958: @WeNurses @Ismalia_S environment, including the urgency of the situation, and others working with patient. #WeNurses
@AgencyNurse
06 October 2016 20:55
RT @fussy1958: Look at your patient and observe them and any clinical data together #wenurses https://twitter.com/connollynursing/status/784119541802631168
@cherylwilson2
06 October 2016 20:55
RT @WeNurses: This is a very good point > #Wenurses https://twitter.com/dormouse107/status/784118705521299456
@NiamhNolan8
06 October 2016 20:56
RT @SueWoodward_KCL: Regardless of stimulus applied, must make sure this is sufficient and not under stimulate #GCSchat #wenurses
@maria_m_roberts
06 October 2016 20:56
#WeNurses Bit late to join! Has anyone discussed re who is doing neuro obs (registered, student nurses or health care support workers)?
@keeling_michael
06 October 2016 20:56
RT @WeNurses: This is a very good point > #Wenurses https://twitter.com/dormouse107/status/784118705521299456
@WeNurses
06 October 2016 20:56
Last question #WeNurses https://twitter.com/Ismalia_S/status/784119950793379842
@NiamhNolan8
06 October 2016 20:56
RT @JFr4ser: @keeling_michael @SueWoodward_KCL plus they must wake the patient up first and assess at that point. Often don't #wenurses
@janewilkinson9
06 October 2016 20:56
Delighted 2 contribute 2 team working of assessment of children's care journey @NCEPOD - privilege 2 b part of study #wenurses #WeCYPNurses
@WeNurses
06 October 2016 20:56
Not yet but good question #WeNurses https://t.co/dlW6nbPBHB
@cherylwilson2
06 October 2016 20:56
RT @WeNurses: Last question #WeNurses https://t.co/rMfm9vCEoU
@AgencyNurse
06 October 2016 20:56
Surely competency not role is key ? #WeNurses https://t.co/e4yFhKut9i
@Ismalia_S
06 October 2016 20:57
@NaomiFleming81 @JFr4ser @nursescott2 @MisterHreben @Marie_Batey probably not but when there's language barrier we should #wenurses #gcschat
@Marie_Batey
06 October 2016 20:57
@nursescott2 @NaomiFleming81 @JFr4ser @MisterHreben @Ismalia_S No, but if they were you would. Yes? #WeNurses #gcschat
@keeling_michael
06 October 2016 20:57
@NaomiFleming81 @JFr4ser @nursescott2 @MisterHreben @Marie_Batey @Ismalia_S always explained to family what, and why doing GCS #WeNurses
@AgencyNurse
06 October 2016 20:57
Good practice as can look quite scary #Wenurses https://twitter.com/keeling_michael/status/784120335503396864
@SueWoodward_KCL
06 October 2016 20:57
@Ismalia_S @WeNurses Always good practice - inter-rater reliability again! #GCSchat #WeNurses https://twitter.com/Ismalia_S/status/784119950793379842
@Ismalia_S
06 October 2016 20:58
@maria_oaktree not yet... we might need to carry out that chat outside this one... or do another one! #WeNurses #gcschat
@WeNurses
06 October 2016 20:58
RT @SueWoodward_KCL: @Ismalia_S @WeNurses Always good practice - inter-rater reliability again! #GCSchat #WeNurses https://twitter.com/Ismalia_S/status/784119950793379842
@mary_titchener
06 October 2016 20:58
RT @fussy1958: Look at your patient and observe them and any clinical data together #wenurses https://twitter.com/connollynursing/status/784119541802631168
@keeling_michael
06 October 2016 20:58
@JFr4ser @NaomiFleming81 @nursescott2 @MisterHreben @Marie_Batey @Ismalia_S say what you see.. #wenurses
@keeling_michael
06 October 2016 20:58
RT @ConnollyNursing: Such a great comment from @Bartontd #wenurses tweetchat-easily transferrable to many clinical scenarios https://t.co/a…
@MandyHollis3
06 October 2016 20:58
RT @WeNurses: This is good advice #WeNurses https://twitter.com/Ismalia_S/status/784119722384224256
@matthewvanloo
06 October 2016 20:58
Trivia question. We all know the current GCS score which is scored out of 15. What was the original GCS scored out of? #WeNurses
@keeling_michael
06 October 2016 20:58
RT @WeNurses: This is good advice #WeNurses https://twitter.com/Ismalia_S/status/784119722384224256
@Luvphotosme
06 October 2016 20:58
#wenurses re q7 GCS and others mentioned part of our twice daily checks - reassess pts if need to on any of the 3 throughout shift.
@Ismalia_S
06 October 2016 20:58
RT @SueWoodward_KCL: @Ismalia_S @WeNurses Always good practice - inter-rater reliability again! #GCSchat #WeNurses https://twitter.com/Ismalia_S/status/784119950793379842
@keeling_michael
06 October 2016 20:59
RT @Ismalia_S: Last question before we close (Q7) Who carries out a GCS assessment during handover? #wenurses #gcschat
@WeNurses
06 October 2016 20:59
Oooh anyone know ? #WeNurses https://t.co/72BPwFwweb
@keeling_michael
06 October 2016 20:59
RT @WeNurses: Last question #WeNurses https://t.co/rMfm9vCEoU
@WeNurses
06 October 2016 20:59
RT @Luvphotosme: #wenurses re q7 GCS and others mentioned part of our twice daily checks - reassess pts if need to on any of the 3 througho…
@cherylwilson2
06 October 2016 20:59
RT @WeNurses: Oooh anyone know ? #WeNurses https://t.co/72BPwFwweb




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