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Observe, Record, Report

Many TBI experts recommend keeping a record of events and activities, but they are not specific about how to do this or what to do with it. We recommend using an awareness process called “O.R.R.” or “Observe, Record, Report” as key tool for helping people with traumatic brain injury move toward recovery.  O.R.R. is an on-going, three-step process for documenting and narrating the symptoms and sequelae caregivers see in the people with TBI they are caring for and sharing it with the appropriate members of their TBI Recovery Team.

Symptoms and sequelae, though addressed in greater depth in a topic specific session, in brief:

Symptoms are the evidence of brain injury seen during the first 48 hours after an injury.

Sequelae are the evidence of brain injury seen after the first 48 hours.

The purpose for the distinction is that symptoms often resolve within the first 48 hours. The remaining symptoms, called “sequelae,” are the aftershocks or secondary effects of a brain injury that can disable a person with TBI for months, and even years, after a trauma. The distinction between the two terms is most important in the early stages of recovery because it places the evidence of the brain injury in a timeframe that the doctors use to determine treatment and testing.

Step 1 – Observe

Caregivers need to be watching for the symptoms and sequelae the person with TBI is experiencing.

  • Notice of what triggers changes in behavior, for example when a person with TBI suddenly becomes agitated or withdrawn.
  • Listen to the way the person with TBI describes how they feel, both physically and emotionally.
  • Be aware of changes in attitude toward recovery or life in general.
  • Watch to see if there are any changes in behavior, energy levels, awareness, appetite or ability to sleep after a medication has been changed or adjusted.

By actively observing the overall state of being of the person with TBI, caregivers connect more fully with the care they provide to the person with TBI, and play an increasingly important role in their recovery.

Step 2 – Record

The second crucial step in O.R.R. is to “Record” what is observed.

By documenting what you see along with the date and time, a record is created that will be used by the TBI Recovery Team to identify and understand what is and is not working in the current treatment plan, and by the caregiver to better manage issues around environment, rest/exertion balance, and overstimulation.

Caregivers should include as much description and context as possible. For example, include the fact that a medication has been changed or adjusted when making a note of a change in behavior. What to record, and how to record it in a way that is concise and focused is included throughout the entire Caregivers Training course.

Step 3 – Report

The “Reporting” step is when information is turned into action.

Observations should always be shared with the TBI Recovery Team members at each appointment. These observations will provide an up-to-date, detailed record of how the person with TBI is responding to treatment, inform changes and shifts in the treatment plans, and in some cases identify potentially life-threatening attitudes before a tragedy occurs.

Observe, Record, Report is the foundation of an informed recovery plan for people with traumatic brain injuries.