Abstracts

Rationale: Despite widespread literature examining the correlation between patient safety and patient monitoring on the Epilepsy Monitoring Unit (EMU), there has not been a comprehensive analysis of whether there are time periods when increased patient monitoring would be more likely to reduce falls. Further, while much of the current research on EMU safety focuses predominantly on minimizing the risk of harm from Epileptic Seizures (ES), Psychogenic Nonepileptic Events (PNEE) account for approximately 15-30% of referrals to EMUs at tertiary care facilities and raise a number of significant, associated safety concerns. This study seeks to determine if there are times when increased monitoring could reduce the number of falls in the EMU due to ES or PNEE.Methods: A retrospective review was conducted of the records of 133 epilepsy and 55 PNEE patients admitted to the EMU between January 2004 and April 2010. Only the first two ES and first PNEE were included for each patient. Daytime was defined as 7:00- 18:59 and nighttime was defined as 19:00-6:59. The falls assessed were those that were directly induced by seizures or events, occurring in the ictal or immediate post-ictal state. The efficiency of staff was assessed through time to staff response to seizures or events (Staff Response Latency, SRL) and the proportion of seizures or events which had staff intervention (Staff Response Frequency, SRF). The Unpaired Student s T-test, Fisher s Exact Test and Nonparametric Binomial Test were used to determine significance, as appropriate ( =0.05). Results: We found that PNEE occurred significantly more frequently during the daytime than at night, with a 65/35 distribution (p=0.03). However, more PNEE-related falls occurred at night (p=0.0001). PNEE-related falls (n=6) occurred significantly more frequently than ES-related falls (n=3) (p= 0.02). All ES-related falls were during seizures that generalized, with 2 during the day and 1 at night. All patient events that occurred Out Of Bed or chair (OOB) were PNEE and at night. Patients were significantly more likely to be OOB during PNEE-related falls (p= 0.0001), with 4 of the 6 falls occurring OOB. There was no difference between the SRL or SRF to PNEE or ES during the day versus at night.Conclusions: PNEE-related falls are most likely to occur at night, typically when patients are OOB, even though the efficiency of staff response to events does not decline at night. Therefore, to reduce fall rates in the EMU, we recommend that staff focus on improving procedures to prevent patients from getting OOB at night.