Abstracts

Rationale: With the increasing prevalence of epilepsy monitoring units (EMUs), neurologists must work to assure quality and consistency of seizure monitoring across large populations of patients. As part of the creation of an EMU within an academic medical center, we evaluated changes observed in various practice patterns, including nurse performance following education in the EMU seizure testing. Such testing is needed to provide the epileptologist with information about the localization and lateralization of seizures. Educational efforts also focused on reducing the number of seizures missed or overlooked by nurses to reduce risk and improve safety of patients hospitalized in the EMU. Methods: After the local IRB approval, data was obtained from a retrospective chart review of epileptic seizures and nonepileptic spells occurring in patients admitted from January-March 2012 compared to patients admitted over the same time period one year later. Major EMU modification was performed in April-November 2012 with the addition of staff, development of a separate unit in the neurology ward, nurse education, EMU protocol establishment and new video EEG (vEEG) equipment with audible alarms to the nursing station triggered by patient's push button and amplifier disconnection. Seizure testing education was completed with EMU nurses between the two study periods via self-directed, online training and personal in-service education. Video data from patient vEEG was evaluated for presence of the patient's nurse and the nurse's behavior of adequate seizure testing in the room during seizures. Results: Thirty-eight patients were admitted in 3-month period in 2012 and 92 patients admitted in 2013. Of 38 patients in 2012, 30 patients had a seizure or event with 22 having vEEG data, and of these 36% were epileptic seizures. Out of 92 patients in 2013, 54 patients had a seizure or event with 40 having vEEG data, and of these 45% were epileptic seizures. Average length of stay (LOS) was 3.05 days in 2012 and 2.75 in 2013. Prior to completion of educational models, a nurse was present during 73% of 22 seizure and psychogenic events with adequate testing performed in 22.7% of the 16 cases in which a nurse was present. Following nursing staff education, a nurse was present during 70% of 40 seizure events with adequate testing performed in 78.6% of the 28 cases at which a nurse was present. Conclusions: EMU modification increased the total number of patients evaluated as well as the percentage of monitored patients with epileptic seizures. This improved efficiency via reduction of average LOS but decreased event or seizure capture rate. Rate of success archiving process and retrieval of data was not different in the two time periods despite new equipment. Use of audible alarms and completion of seizure testing training by nurses did not confer improved recognition of seizure events but did improve the adequacy of nurse-performed seizure testing following an event. Future development of the nursing education course and use of adjunct methods to alarm potential seizures and events should place emphasis on nurse recognition of seizure events.