Abstracts

Rationale: Epilepsy monitoring using long term electroencephalography (EEG) and video to help classify and localize seizures is a common practice used by epileptologists when treating patients with medically intractable epilepsy and nonepileptic events. This is performed usually in designated epilepsy monitoring units (EMU) with the assistance of physicians, technicians, and nursing staff to monitor patients. To localize seizure onset and to classify seizure type, the physician must capture events typical for the patient. In the general population, epileptics have an increase risk of injury from seizures and seizure related falls. Injury is usually due to head and soft tissue injury, drowning, fractures, burns, and motor vehicle accidents. Despite care taken to insure the safety of patients off of medications, injury does occur due to seizures in the EMU. In an extreme case, an epileptic patient died in an EMU in Colorado as a result of their seizure after suffocating in a pillow overnight when staff resources were limited. Also, despite monitoring being a common practice, no set protocols exist on how to wean patients appropriately from their medications, how to properly care for a patient during a seizure in the EMU, how to properly arrange the physical environment in the EMU to ensure patient safety, how many seizures should be recorded, and how long to monitor patients. Our objective was to determine the frequency of seizure related injury and complications in the EMU and to identify what factors contributed to these complications including nursing care, technical issues, issues with the physical environment, and issues related to the seizures themselves. The goal ultimately is to highlight potential injury causing factors that may be common to all EMUs to drive the creation of formal standard guidelines for EMU monitoring. Methods: We reviewed medical records and long term video EEG of epileptic patients admitted to our EMU from December 1, 2008 - June 1, 2009. Data was collected on seizure type, onset, length, and frequency. Seizure related falls, injury, and adverse events were recorded. Data regarding the physical environment and nursing care during seizures was analyzed too. Results: 20 patients with 170 seizures were collected. 6 (30%) patients had seizure related falls, 1 with injury (5%), requiring further testing. 5 (83.3%) falls were related to patients being ambulatory. No seizures resulted in prolonged stay. Other adverse events included 1 status epilepticus (0.6%), 2 postictal aggression (1.2%), 4 objects in mouth during seizure (2.4%), 14 ambulatory during seizure (8.2%) and 5 postictal wandering (2.9%). Nurses were aware of 69 seizures (40.6%). The lack of response in most cases was due to electrographic seizures without seizure detection software or push button activation (57, 56.4%). Conclusions: Falls and adverse events that can lead to injury occur in the EMU, yet the degree of actual injury is minimal. To improve safety outcomes, standardized protocols with appropriate outlined nursing care and procedures for continuous monitoring of patients by staff need to be employed.