Abstracts

Rationale: Rationale: Falls are a major safety issue in the epilepsy monitoring unit (EMU). Falls in the bathroom are a particular concern as patient supervision must be balanced with privacy concerns. In the bathroom lack of video monitoring, hard surfaces, and limited space could all compromise the ability of staff to recognize and respond to events. Little is known about the absolute fall risk in the EMU bathroom and current safety practices vary widely among epilepsy centers. The purpose of this study was to quantify the frequency of falls in the bathroom and the risk of injury, as well as to determine if certain event types are more likely to occur in the bathroom. Methods: Methods: A retrospective review of 616 consecutive adult admissions to the Mayo Clinic Arizona EMU from January 1, 2008 to December 31, 2010 was performed. Any clinical event described by the patient or witnessed by EMU staff was included. Data was collected on event type, location (in bathroom or not), and whether or not there was an associated fall. Results: Results: There were 1767 recorded events resulting in 10 falls. 140 patients had 675 cumulative clinical seizures: 4 (0.6%) were associated with a fall and 4(0.6%) were in the bathroom. 157 patients had 651 cumulative psychogenic non-epileptic events (PNES): 4 (0.6%) were associated with a fall and 8 (1.2%) were in the bathroom. 2 of 135 non-epileptic physiologic events (1.5%) resulted in a fall (both from syncope), and 2 (1.5%) were in the bathroom. Differences in fall frequency or percentage of events occurring in the bathroom by spell type were not statistically significant. 4/10 falls (40%) occurred in the bathroom, 2 with seizure and 2 with PNES. The only 2 falls resulting in injury were from seizures in the bathroom, both injuries were minor. No major injuries occurred. Seizures in the bathroom were significantly more likely to result in fall (2/4, 50% vs. 2/671, 0.3%; p=0.0002). PNES in the bathroom were also significantly more likely to result in fall (2/10, 20% vs. 2/641, 0.3%; p=0.0013). Conclusions: Conclusions: With safety precautions including limited mobility and close 1:1 supervision of patients when out of bed, falls occurred in 1.6% of EMU admissions and were associated with minor injury in 0.3% of admissions. Seizures, PNES, and other physiologic events were no more likely to occur in than out of the bathroom. Seizures and PNES occurring in the bathroom were more significantly more likely to result in falls. Bathroom safety precautions are justified given the risk of fall and injury.