Abstracts

Rationale: In the Epilepsy monitoring unit (EMU), patients are admitted to have their seizures observed for accurate diagnostic and treatment purposes. Their seizure threshold is decreased by lowering their medications. Whenever the patient experiences a seizure event concerning for seizure, a family member or relative staying with them is instructed to press the “push button” to call in the nurse. However, it was noted that the nurses responded slower to the pediatric push button events than the adults. We analyzed that pediatric seizures often are perceived to be non-emergent and there were more pediatric push button events as compared to adults and hence the delayed response of the nurses. We then implemented a quality improvement (QI) program to improve the nurse’s response time for the pediatric patients push button events in EMU.

Methods: A QI project has been initiated to improve nursing staff’s response time to call button incidents in EMU at our children’s hospital. A multidisciplinary QI team participated which comprised of a, Neurodiagnostic EEG lab clinical operation director, EEG technicians, medical director pediatrics EMU, pediatrics nursing in charge, and epilepsy nurse. We analyzed every seizure in the EMU recorded during December 2020. The discussions progressed through the PDSA (plan, do, study, act) cycle of improvement to identify gaps and implemented appropriate interventions. These included: 1) A new record sheet has been introduced to accurately record time in minutes and seconds; 2) Besides medical assistants, nurses can make “No call” to seizure event and determine information like frequency, duration, and seizure types to analyze if they can be made a no call earlier; 3) Nursing staff being motivated by showing clipped videos of what patients and family members go through in real-time during emergent seizures to quickly respond to all button presses. The first PDSA cycle was conducted in April 2021 and the second cycle is scheduled for August 2021.

Results: During December 2020 (Table1), 61% push button event in adults EMU (N=17) were responded to in under 30 seconds and 39% (N= 12) were responded to between thirty seconds to one minute as opposed to 17% (N= 14) and 48% (N=40) children in the respective time frames. About 4 months after the implementation of the multiple interventions in April 2021 (Table 2), 50% of pediatric (N=26) patients were attended in less than 30 seconds and only 31% were attended between thirty seconds to one minute, whereas, 51% (N=46) and 49% (N=32) of adult participants were attended in aforementioned intervals.
Table 1: Nurses' response time to call button events during December, 2020.
Table 2:Nurses' response to call button events during April, 2021.

Conclusions: Our study was successful in improving the nurses' response during seizures in a pediatric EMU. Implementation of a structured process to record accurate time, better utilization of no call feature and raising the awareness and motivating nursing staff has greatly improved the response time. These steps can be implemented in any EMU to improve the response time. We will continue to improve the process and share the result of next two analyses at AES.

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