Abstracts

Rationale: We previously identified through a retrospective chart review seizure safety indicators and protocols were not implemented appropriately in an epilepsy monitoring unit (EMU) and determined a need for quality improvement initiatives (T. Yates et al. (2022) Safety Measures in the Epilepsy Monitoring Unit: An Organizational Assessment. AES 2022 Annual Meeting Abstract Database. AESnet.org). The first aim of this quality improvement project was to develop a Multidisciplinary EMU Safety Committee and implement quality improvement initiatives. The second aim was to complete a systematic post analysis to compare seizure safety indicators after the implementation of quality improvement initiatives.


Methods: We developed a Multidisciplinary EMU Safety Committee through Stakeholder Mapping. Quality improvement initiatives were employed by the Committee in May 2022 through August 2023. We used several quality improvement modalities including the Model for Improvement and Six Sigma Methodology. The second aim of the study was to complete a retrospective systematic post analysis of patients admitted to the EMU from September 2023 through May 2024. The same inclusion criteria from the initial project will consist of patients who developed a generalized tonic-clonic (GTCs) seizure. Four data abstractors will collect seizure safety indicators and use descriptive analysis.


Results: The Multidisciplinary EMU Safety Committee key stakeholders implemented a variety of quality improvement initiatives including (1) reviewed and updated epilepsy protocols based on best practices in September 2022 (2) developed a seizure response action plan in October 2022 identifying responder roles (3) developed a core-epilepsy team with epilepsy-trained nurses and nursing assistants with epilepsy experience in 2022 through 2023 (4) provided staff education sessions through online didactic learning, onsite real-time education, seizure simulations, and provided opportunities for direct feedback in 2022 through 2023 (5) EMU patient hospital status was changed to intermediate care, allowing for a lower nurse-to-patient-ratio of 4:1 in March 2024. Since practice changes, the Epileptologists reviewing EEG recordings and video EEG monitoring subjectively reported improvement in nursing interventions and responses to seizures. Therefore, a systematic post analysis for reliability and validity, to evaluate signs of progress and success is underway.


Conclusions: We employed quality improvement initiatives to lower EMU-related seizure emergencies, injuries, adverse events, and fatalities. We anticipate the systematic post analysis will signify improvements in all seizure safety indicators and/or identify problem areas for further improvement. Most importantly, the project will determine ways to maintain sustainability.


Funding: None