Abstracts

To date, there has been no established nursing research conducted evaluating the effect nursing response time to epileptic seizures has on patient safety.
In response to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) focus on patient safety, a study was initiated. The purpose of this project was to identify (1) if a benchmark response time to seizures is needed, and (2) to examine the relationship between response time and patient safety. This project involved retrospectively looking at archived EEG and video files to determine how quickly nurses responded to epileptic seizures in a dedicated epilepsy monitoring unit. The data was collected over 23 months and involved 130 patients. Initially, a target response time was set at 15 seconds. Following preliminary analysis, it was determined that at least 10 seconds of abnormal EEG was needed to establish whether the pattern was indicative of a seizure or epileptiform discharges not requiring nursing intervention. Therefore, a decision was made to increase the threshold to 25 seconds from onset of EEG change to nurse at the bedside. This study sample yielded no injuries involving unassisted falls, fractures, wounds requiring sutures, or ER visits. On occasion, patients sustained buccal trauma, minor bruising or abrasions which were directly attributable to the ictal or postictal periods. None of these required additional labs, diagnostic radiology, or increased length of stay.
It was found that nurses responded to seizures an average of 23 seconds from EEG onset over the study period of 23 months. Throughout these months, there were variances in the response times ranging from zero seconds (nurse present at seizure onset) to over 60 seconds or more. These variances did not appear to significantly impact patient safety. The results of this study underscore the importance of establishing a benchmark response time but falls short of identifying what specific amount of time is indicated. Perhaps a response time of 20 to 35 seconds should be considered. There are benefits to prompt response which can be identified. These include providing supportive care to patients during the ictal and post-ictal states (i.e. administration of oxygen, airway management, comfort measures, and safety), an enhanced feeling of comfort for patients and their families, and improving quality of ictal SPECT scans performed on pre-surgical candidates.
This study does demonstrate that further research on this subject is warranted and a future multi-center study of response time to epileptic seizures would be beneficial in determining a standard of care to be utilized by dedicated epilepsy monitoring units.
Also, it would be of interest to examine nursing response time as it relates to safety on a dedicated epilepsy monitoring unit versus an epilepsy monitoring unit that is incorporated in a non-dedicated hospital area.