Abstracts

Rationale: Quality and safety of care in hospitals is being increasingly scrutinized. Because of the methods used to induce seizures (e.g. antiepileptic drug withdrawal), patients in the SMU are more likely to experience generalized tonic-clonic seizures (GTCs), which may increase their risk of injury. In order to mitigate the risk of injury to patients, the proper management of seizures in the SMU is essential. The objectives of this study were to: 1) develop a tool to evaluate the management of GTCs, and 2) evaluate the management of GTCs in a SMU using the newly developed tool. Methods: (1) Tool development: Key steps to the management of GTCs were first identified through a literature search. The list of items was refined using SMU expert opinion (epileptologists, neuroscience nurses, EEG technologists, quality/safety personnel). Once consensus was reached, a tool was created which examined Safety, Assessment, and Management (SAM) of GTCs in the SMU. (2) Tool implementation: The tool was applied retrospectively on two separate samples to all GTCs captured on video-EEG in the SMU between January 2008-December 2009 and again between January 2011-May 2012 after the implementation of general education sessions (not specifically targeting the tool or the management of GTCs) for SMU nursing staff. An overall completion rate for every step and percent of steps completed was calculated for each "SAM" category. Descriptive statistics (means and frequencies) were generated and student t-test and correlation analysis were performed to examine differences between tests administrations. Results: A 17-item GTC management rating tool was created. The tool consisted of three categories: safety (6 items), assessment (4 items) and management (7 items). All items on the tool were forced choice (complete/NA or incomplete). There were significant improvements overall, and in each category (p < 0.001) from the first administration to the second. The safety category improved over time by 6.6% (p<0.01), the assessment category by 7.7% (p <0.01) and the management category by 19.5% (p<0.001). Overall, the mean number of steps completed was 67%. Of the three components of the rating tool, the management category was on average the most completed category (mean steps completed = 75.3%) while the assessment one was the least completed (mean steps completed = 45.4%). Conclusions: The results of the present study revealed areas for potential improvement in the management of GTCs in a SMU. Despite this, it is encouraging that a large proportion of the safety and management aspects of caring for patients during a GTC, are being executed. A significant improvement was observed in the management of GTCs over time, possibly as a result of the implementation of a general training course introduced for staff in our SMU. We therefore plan to create a training module specific to GTC management, to further improve the management of GTCs in the SMU. The tool will be implemented prospectively after the SMU staff has completed the GTC management training module.