Abstracts

Rationale: Video electroencephalogram (EEG) monitoring is commonly used to further evaluate patients who are experiencing epileptic seizures and nonepileptic seizures. Provocative measures used to induce seizures and seizures themselves may place the patient at increased risk for injury while hospitalized. Nursing interventions are key to providing a culture of patient safety while patients are undergoing video EEG monitoring. However, nursing practices vary greatly among institutions and there are no standardized guidelines. In order to develop evidence based guidelines for video EEG nursing care, we determined the frequency of nursing interventions for complex partial seizures (CPS), generalized tonic-clonic seizures (GTC), and nonepileptic seizures (NES). Methods: Video EEG monitoring data was retrospectively reviewed for all patients in the epilepsy monitoring unit from January 2004 until Aril 2010. Only those seizures where the video was unobstructed were included in data collection. A maximum of two seizures were documented for each patient. Results: A total of 274 seizures were analyzed from 220 patients. Three patients accounting for five seizures had implanted electrodes. The majority of all the seizure types occurred while the patient was in bed. Fourteen occurred while the patient was sitting in a chair. Use of restraints was required in one patient after experiencing a GTC seizure. One patient attempted to remove their EEG leads also after a GTC seizure. Ictally no patients were placed into lateral decubitus position in the complex partial group, but eleven patients experiencing NES, and twenty three patients experiencing GTC seizures were turned. An additional twelve patients were placed into lateral decubitus position after a GTC seizure. Oxygen was applied to one patient experiencing NES and three patients experiencing GTC seizures during the seizure. Four patients experiencing NES and 20 experiencing GTC seizures had oxygen placed after a seizure. One patient required suctioning after a CPS, one during a NES, nine during a GTC, and thirty five after experiencing a GTC seizure. Four patients attempted to get out of bed during a CPS, four experiencing NES, and two after experiencing a GTC seizure with clinicians present in five instances. Three patients experiencing GTC, and six experiencing NES fell during a seizure. There were no falls in the CPS group. One patient sustained a soft tissue wrist injury. Sixteen patients pushed the event button prior to a CPS or GTC seizure, and eleven prior to a nonepileptic seizure. Conclusions: Nurses and nursing interventions ensure patient safety while patients are undergoing video EEG monitoring. Our results show greater nursing resources are needed for those patients experiencing generalized tonic-clonic seizures. However, nursing vigilance is needed for all patients regardless of seizure type. Similar studies at other institutions are needed to aid in the development of generalizable nursing care guidelines.