Ever since 1974, Glasgow Coma Scale has provided a practical tool for bedside assessment of impairment of conscious level (Teasdale et al., 2014). While widely adopted in general and specialty units, variations in techniques in performing the assessment have emerged over time affecting reliability and communication (McLernon, 2014). In 2014, the details of the scale composition and its application were reviewed. A structured approach to assessment was set up which facilitated to deliver a basis for standardizing practice and to ensure the scale was useful and practical (Teasdale et al., 2014).
In this update, terms under three modes of behavior: eye opening, verbal response and motor response have been clearly described aimed at minimizing ambiguity. ‘Not testable’ term is added in each of the three modes of behavior. Denote ‘NT’ when there are patient factors such as swollen eyes, intubated or paralyzed which affect the rating of GCS (Teasdale et al., 2014).
In Hong Kong Hospital Authority, most hospitals and specialties are still adhering to the previous version of GCS, introducing inconsistencies. Therefore, an evidence based practice approach is used to justify the advantages of new version of GCS. Literature review has been done to study the best practice to increase the reliability of GCS. Literatures advocated that reliability for the GCS components was higher than for the sum score (Reith et al., 2016). It is important to apply standardized approaches whenever a component is untestable. A non-numerical designation ‘NT’ should be assigned (Reith et al., 2016). In addition, factors like education / training, level of experiences, type of stimulus and conscious level of patient may affect the reliability of GCS (Reith et al., 2017).
For that reason, an e-learning material was developed to train HA staff on the updated version of GCS and related neurological assessment. The e-learning has been launched since December 2023 and an evaluation will analyze inter-rater reliability between nurses post-training. Standardizing applications can enhance GCS usefulness and consistency for improved patient outcomes.
