Abstracts

Rationale: Not all the clinical components of a seizure can be assessed with video-EEG alone, without the use of a reliable “Observer” who can directly interact with the patient to evaluate certain clinical features of the seizure, such as language and level of awareness. Information that is elicited through direct interaction, assessment, and observation during and after the seizure by skill registered nurses can provide epileptologists with further information to localize the epileptogenic foci, in addition to the EEG findings. Improving the accuracy and reliability of a registered nurse’s ictal and postictal assessment can be dramatically helpful to the physicians as well as patient safety.Methods: One-hundred events experienced by patients within three-month period of time in our EMU were randomly chosen for review. One investigator reviewed the videos of nursing ictal and post ictal assessment for each event. The following components were analyzed: event duration (less than thirty seconds vs. thirty to sixty seconds vs. more than sixty seconds), response time, completion of ictal and post ictal assessment (complete vs. incomplete vs. missed), seizure type (non-epileptic vs. epileptic), time of the event (diurnal vs. nocturnal).Results: Seizure Duration: Thirty-one events were less than thirty seconds, thirteen events were thirty to sixty seconds, and fifty-six events were more than sixty seconds. Response Time (average): For events less than thirty seconds, response time was 37 seconds (most of the time, RN entered room after seizure ended), for events thirty to sixty seconds long, response time was 36 seconds, and for events more than sixty seconds, response time was 65 seconds. Interestingly, the average response time is better during the night compared to day time. Seizure Type: Sixty-nine out of hundred events were epileptic. Completion: Incomplete ictal, postictal and missing assessments were greater in the epileptic events (23 events, 39 events and 9 events respectively) compared to non-epileptic events (10 events, 15 events and zero event respectively). ( Percentages inTable 1) Diurnal Variation: No significant difference was noted between diurnal versus nocturnal events in term of the percentage.Conclusions: The incomplete ictal/postictal or missed assessment of epileptic events may be due to multiple factors, including the nurse being unable to recognize when a seizure has started or stopped, the nurse being distracted with other tasks during the seizure (such as administering oxygen), and unfamiliarity with the assessment exam. After the above review, all EMU nurses attended a one day refresher course on ictal and postictal assessment. The investigators will now review one hundred new events to determine if there has been an improvement in the components described above.