Abstracts

Rationale: Continuous portable long-term video EEG monitoring (CVEEG) is commonly used in the diagnosis of paroxysmal spells and seizures and in monitoring seizure frequency. Unlike in epilepsy monitoring unit and out-patient VEEG, CVEEG is not performed in a constant real-time monitored setting and brief clinical spells are likely to be missed leading to patient injury. The aim of this study was to educate nursing staff via an online educational module regarding early identification, assessment and safety measures of witnessed clinical spells and to determine assessment of spells before and after completion of the module. Methods: Following IRB approval, an online educational module on seizure safety precautions was designed and available from 12/2011 until 02/2012 (training period) for the nurses who consented for the study. Pre and post training tests were included, and scores of only those who completed both were considered for analysis. Independently, patients undergoing CVEEG from 9/2011 through 11/2011 (pre-training period) and from 02/2012 until 04/2012 (post-training period), with clinical seizures, were included. CVEEG was reviewed by 2 physicians (AZ, RI) using an evaluation tool for identification and assessment of the recorded clinical spells in these period. Results: A total of 17 complete responses of the online educational module pre and post training scores were analyzed. Mean of the pre-training scores was 76.2 (s.d.=15.7) and the post-training scores (first test score) was 80.1 (s.d.=16.0) (p=0.267, paired t-test). In addition, the correct responses for each of the six questions were investigated (Table 1). Independent review of CVEEG identified 83 patients with 96 studies in the pre and 53 with 59 studies in the post-training period. Table 2 shows the gender, age and the rates for clinical seizures, sub-clinical seizures and non-epileptic spells on those patients within the two time periods. No significant differences were detected between these two groups. Slightly but not significantly more clinical seizures in studies were recorded during the pre than in the post training period (20% vs 9%, p=0.057). The difference between the number of witnessed clinical seizures or non-epileptic spells during the pre (73%) and the post (56%) training period was not significant (p=0.436, Rao-Scott chi-square test). Forty percent (10/25) of these were assessed during the pre compared to 56% (5 of 9) for the post training period, but the difference was not significant (p=0.287, Rao-Scott chi-square test). Conclusions: Although there was no significant difference in the survey responses before and after training the nurses on an online educational module, adequate assessment of witnessed clinical events by the nursing staff increased implying possible improved awareness regarding seizure identification and safety precautions. This prospective study indicates that periodic delivery of educational information to nursing staff could be one step towards enhancing safety and delivery of appropriate care in patients on CVEEG.