Abstracts

Rationale: The AES Expert Consensus on EMU Patient Safety identified a need for the creation of standards in patient care and safety measures in EMUs across the U.S. . Very few studies have documented the EMU-associated risks and provided solutions to address safety challenges. We present our EMU safety data and describe changes in EMU practices that improved patient safety. Methods: We reviewed the Safety Assessment Database developed at Henry Ford Hospital EMU to monitor adverse outcomes such as falls, missed seizures by the EMU monitor, delayed nurse response, failed alarms, non functioning resuscitation equipment, lack of restraints when needed, suboptimal EEG recording and delay in medication administration. All the incident video-EEGs are saved for root cause analysis. EMU falls are monitored daily by the hospital and a report is generated weekly. We used the Monitor, Measure, Modify and Implement approach to identify gaps, opportunities for improvement and implement new tools to address safety. Results: From 2007 through 2010, 854 patients (344 of which for presurgical work-up) were admitted for 5332 monitoring days. Despite 24-hour patient surveillance by EEG techs and Medical Assistants, we had a total of 15 falls one of which resulted in a fracture of the clavicle and 30 missed seizures without serious sequelae. We had 2 patients with ictal asystole, and 2 with status epilepticus due to medication withdrawal. We had no vertebral fractures, no dental injuries, no aspiration pneumonia and no deaths. We attributed the increased rate of falls to inconsistencies in applying and reinforcing preventive fall measures and missed seizures to inadequate alertness of the EMU monitors. In 2009 we launched the EMU Safety Initiative that included identification of patients at higher risk for falls; falls contract signed by the patient or caregivers to highlight the risk of falls and the preventive measures; direct supervision at all times when patients are in the bathroom or exercise; weekly EMU fall report; recruitment of entry level EEG techs for patient surveillance after-hours; outside the room charting by nurses; and round-the-clock nursing rounds to assess Pain, Personal needs, Pulmonary Hygiene, Position, Possessions, Place (6Ps); continuous education of medical, nursing, EEG tech staff. We had 11 falls and 26 missed seizures prior to implementation of the new measures and only 4 falls (no falls in 9 consecutive months) and 4 missed seizures following our Safety Initiative that resulted in 63.3% reduction in falls and 84.6% fewer missed seizures. Conclusions: Increased awareness about EMU safety, intensive education of the epilepsy team and implementation of new practices helped us reduce the average fall rate of 3.07 per 1000 bed days to 2.28. Continuous review of safety practices in the EMU provides many opportunities for improvements by modifying current unsafe practices and implementing tools to obtain tangible positive outcomes. By developing national EMU safety benchmarks, we work towards safer EMUs and potentially establishing accreditation of EMUs similar to the Stroke Units.