Activity 2: Decision making online journal (25%)
Over the course of semester your will be required to frequently reflect on experiences from practice where you have utilised your advanced assessment skills and decision making within your allocated journal discussion group. For this task you are required to:
1) Share with other students, minimum of four (4) practice experiences where your assessment skills/decision making altered or had significant impact on the outcome for a patient (300 words x 4).
2) Contribute regularly to the discussion area, assisting other students with their individual applied assessment episodes.
3) Draw upon the evidence that informed your decision and provide justification using evidence-based literature.
4) Identify any challenges you may have in your work context.
5) Respond to minimum of one other student and provide an alternative solution to their decision, again using evidence-based literature to support your claims (300 words).
6) Select postings for grading, these should be from different areas of practice (for example, respiratory, neurological, renal, haemodynamic, or other) to show your increasing clinical development.
7) Collate your best five (5) discussion postings, (1500 words), as part of your clinical skills portfolio.
Student’s post for response
• A 21-year-old male admitted to the trauma ward following a motor vehicle accident.
The patient had been travelling at approximately 70 km/hr when he lost control and he had a head on collision into a tree. Following primary and secondary surveys the patient was found to have a 10cm laceration to his forehead. Due to this laceration and obvious head strike the patient underwent a computed tomography scan (CT). There were no obvious abnormalities to the patient’s head CT scan. Nil other injuries were identified. The patient’s past medical history included smoking 10 cigarettes per day.
On arrival to the ward, I asked the patient several questions surrounding his accident. A main focus of mine during this patient interview was whether the patient had a loss of consciousness from the trauma. The laceration to his forehead indicated to me there was a potential for a loss of consciousness. He was unsure whether he had lost consciousness however he was amnesic to events directly after the accident occurred and could not remember the time between having the accident and the paramedics arriving. A history of loss of consciousness or post traumatic amnesia is commonly used as an indication for futher investigations and observations (Ganti et al. 2019).
After interviewing the patient and determining the patient’s amnesia, I decided the patient met the criteria for the Abbreviated Westmead PTA Scale (A-WPTAS). A-WPTAS assesses the patient for PTA providing an early and efficient assessment for patients with possible mild traumatic brain injuries (TBI). It helps to identify any cognitive impairment and the need for any further intervention and ongoing care (Watson et al, 2017).
Following my assessments using the AWAPTAS guidelines the patient was unable to meet the criteria that would have cleared him from PTA. The patient was then referred to the occupational therapists for regular PTA testing. The PTA testing requires a score of 12/12 for three consecutive days which the patient managed to meet on day 7 of admission. The length of time for PTA is an important diagnostic and outcome indicator for patients with suspected TBI (Hennessy et al, 2020).
He was deemed to have a mild TBI and was referred to the Hunter Brain Injury Service for outpatient follow-up. A mild TBI is considered where there is trauma leading to temporary changes of the patient’s neurological function. This deficit should improve with time (Tranter-Entwistle et al, 2021).
My decision to commence initial A-WAPTAS and avoid delays to these assessments meant the patient’s TBI was diagnosed in a timely manner and the patient received the appropriate intervention and care he required both as an inpatient and in the community on discharge.
Latha Ganti et al. (2019) ‘GCS 15: when mild TBI isn’t so mild’, Neurological Research and Practice, 1(1), pp. 1–8. doi: 10.1186/s42466-018-0001-1.
Hennessy, M. J. et al. (2020) ‘Optimizing and simplifying post-traumatic amnesia testing after moderate-severe traumatic brain injury despite common confounders in routine practice’, Journal of Clinical Neuroscience, 81, pp. 37–42. doi: 10.1016/j.jocn.2020.09.030.
Tranter-Entwistle, I. et al. (2021) ‘What a headache! Reviewing mild traumatic brain injury management in a new trauma service’, The New Zealand medical journal, 134(1531), pp. 59–66. Available at: https://search-ebscohost-com.ezproxy.utas.edu.au/login.aspx?direct=true&db=mdc&AN=33767477&site=eds-live (Accessed: 7 September 2021).
Watson, C. E. et al. (2017) ‘Introduction of the Abbreviated Westmead Post-Traumatic Amnesia Scale and Impact on Length of Stay’, Scandinavian journal of surgery?: SJS?: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 106(4), pp. 356–360. doi: 10.1177/1457496917698642.