Abstracts

Rationale: The importance of improving the quality and safety of care in hospitals is increasingly recognized. Epilepsy Monitoring Units (EMUs) are unique environments that may expose patients at increased risk of adverse event because of the occurrence of seizures, including generalized tonic clonic (GTC) seizures. To mitigate the risk of adverse events, the proper management of seizures in the EMU is essential. Our objective was to determine if the implementation of a GTC seizure-specific training module would improve the management of GTC seizures in an EMU.Methods: EMU nurses were asked to complete a training module that consisted of a brief Powerpoint presentation with accompanying audio, which discussed the proper management of GTC seizures in the EMU. A rating tool was employed to evaluate the safety, assessment and management of GTCs in the EMU before (January 2011 to May 2012) and after (July 2012 to May 2013) the GTC seizure management training. The 17-item rating tool assesses the completeness of care that patients experiencing a GTC seizure receive. In order to control for extraneous factors not related to the training intervention, GTC seizures managed by nursing staff without training (control group) were also examined.Results: Of the nursing staff managing GTC seizures captured in this study, 42.9% completed the training module. At baseline (pre-training), the nurses who eventually completed the training managed the GTC seizure more completely than those who did not complete the training (p=0.037). Nurses who completed the training had greater improvements in their management of GTC seizures than those who did not complete the training (p=0.015). This finding was not significant when we examined only the nurses who completed the training - there was no significant improvements in their overall management of GTC seizures post-training intervention (mean=67.7%) compared to pre-training (mean=66.2%; p=0.633).Conclusions: We did not find a significant difference in the management of GTC seizures in the EMU between pre- and post-training, in those nurses that completed the training. Interestingly, we did find that nurses that completed the training managed GTC seizures more completely, regardless of the training intervention, suggesting that factors other than the training intervention impacted the management of GTC seizures in the EMU. The reason for the non-significant findings could be two-fold. One reason is the small sample of nursing staff that completed the training and managed GTC seizures in the EMU during the study period. Secondly, the training module may not have been sufficient to change the clinical practice of the nursing staff. Further exploration is needed to determine the best method of improving the safety, assessment and management of GTC seizures in the EMU.