Abstracts

Rationale: Long-term video-electroencephalography (EEG) monitoring in the epilepsy monitoring unit (EMU) is an elective procedure and generally safe. Clinical experts determined the EMU protocols at a level-4 comprehensive epilepsy center were not followed correctly. Our aim is to evaluate if there is compliance with safety protocols in the EMU and determine whether a need exists for quality improvements.  _x000D_
Methods: A retrospective chart review was conducted for patients admitted to the EMU from September 2021 through November 2021. Inclusion criteria consisted of patients who developed a generalized tonic clonic (GTCs) seizure with electrographic epileptiform correlation. Data abstractors collected seizure safety indicators from eleven patients with fifteen GTCs. 

Results: Of the fifteen GTCs, the seizure safety efficiency indicator revealed an average GTC was 92.7 seconds, and the time to responder response was 43.6 seconds. The GTC management and seizure precaution indicators showed as follows: suction set up 53% (n=8), suction initiated 60% (n=9), vital signs recognized 67% (n=10), no vital signs vocalized 53% (n=8), vital signs obtained 40% (n=6),  performance of any neurological assessment 60% (n=9), patients turned on their side 13% (n=2), and objects removed to cause injury 80% (n=12). Other indicators included four side-rails up 93% (n=14), identification of appropriate bed position 100% (n=15), continuous pulse oximetry 13% (n=2), and IV access and continuous telemetry 80% (n=12). Interventions to stop seizure indicators included: no vocalization of Ativan administration 67% (n=10), and no vocalization of notifying physician 60% (n=9). During the postictal stage: variation of a neurological assessment 87% (n=13), variation of vital signs 73% (n=11), and postictal suctioning occurred 80% (n=12). Medication change indicator revealed antiepileptic drugs (AEDs) were stopped in 20% (n=3). Of the fifteen GTCs, no medical team response in 13% (n=2).  _x000D_  
Conclusions: The project identified practice gaps in all seizure safety indicators, necessitating further investigation. Healthcare performance improvement efforts or quality improvement initiatives to lower EMU-related seizure emergencies, injuries, adverse events, and fatalities should be employed to prevent seizure safety concerns during an EMU evaluation. Healthcare performance and quality improvement measures and methodologies foreseen to implement change include (1) fishbone cause and effect diagrams (2) Pareto analysis charts (3) root cause analysis (4) formal and informal education (5) step-by-step nurse-driven protocols (6) face-to-face real-time feedback discussions (7) debriefing opportunities, (8) repeating a 3 to 6 month chart review, and (9) consideration of a multidisciplinary EMU committee regularly evaluating and developing ways to sustain change._x000D_
Funding: None