Abstracts

Rationale: Patients who have intractable seizures despite maximal medical and dietary management are considered for therapeutic surgical intervention and often require intracranial electrodes for localization of seizures and mapping of eloquent cortex. Patients with surgically implanted electrodes are at high risk for complications such as hemorrhage and infection which are minimized by using safe surgical technique and detected by frequent assessment, prompting urgent intervention where necessary. Antiepileptic medications are often weaned post operatively to capture seizures, increasing the risk of status epilepticus in the epilepsy monitoring unit. Nursing orders are comprehensive but urgent orders can be difficult to find under duress. An individualized reference board highlighting critical orders for the treatment of status epilepticus and identifying on-call physicians has helped maintain a flawless safety record for the Comprehensive Epilepsy Program at Riley Hospital for Children.

Methods: To improve communication and advance patient safety, the intracranial electrode safety board (IESB) was placed in the rooms of patients during phase 2 monitoring with a themed template for quickly directing bedside caregivers to respond to patient needs. This portable, erasable white board is prominently displayed on the bathroom door and highlights a patient’s seizure rescue plan, activity restrictions, on-call physicians, and future operating room date. The IESB is completed by physicians/advanced practice providers and discussed with the bedside nurses and neurodiagnostic technologists upon admission to the epilepsy monitoring unit.

Results: There is no historical data to quantify the benefits of the IESB. Despite intracranial electrode patient volume at our center growing eightfold from two in 2017 to sixteen in 2020, zero patient safety events have occurred with implementation of the IESB. Overall, patients, nurses, neurodiagnostic technologists, and physicians refer to the board daily to direct patient care, reinforcing a standardized and safe patient experience.

Conclusions: The IESB reinforces communication among health care team members and family. Although orders are placed in the patient’s electronic chart, the board quickly clarifies the seizure rescue plan, activity restrictions, type of monitoring, tentative surgery date, and on-call Epileptologist/Neurosurgeon for bedside caregivers. This streamlined and accessible documentation directs patient care in a variety of settings, possibly hastening the delivery of antiepileptics where appropriate, reducing variability in patient care between caregivers, and maintaining a clear medical and surgical plan for families in the unit. While documenting in the electronic medical record should be thorough and complete for these complex patients, our experience suggests the IESB is a helpful tool during phase 2 epilepsy surgery evaluations for efficiently directing patient care while maintaining low patient safety events.

Funding: Please list any funding that was received in support of this abstract.: None.