Abstracts

Rationale: Patients are admitted to Epilepsy Monitoring Units (EMU) across the country for diagnosis and evaluation of seizures. Increasingly, the rationale for admission is accurate seizure localization and consideration for surgical intervention. These patients are frequently tapered off their anti-epileptic drugs during admission, leaving them vulnerable to seizures of increased duration and severity. There is an agreement among practitioners and clinical staff members who work in these areas that there should be around-the-clock observation by trained healthcare staff (Phillips, 2008). Some units have 24-hour dedicated staff observing patients, while others supplement care with video monitoring or request the assistance of nonclinical personnel or family members staying with the patient (Gandey, 2008). Methods: The staff at Barrow Neurological Institute (BNI) Saint Joseph’s Hospital and Medical Center (SJHMC) recognized the need for continuous observation of patients. Awareness was heightened with regard to the importance of timely seizure event detection, individualized patient assessment, and close monitoring when patients are out of bed (Velis, Plouin, & Gotman, et al., 2007). Staff developed and formalized a job description for the EMU monitor registered nurse (EMRN). Reapplication of electrodes and maintenance of EEG tracings are responsibilities of the EEG technician (tech). The ongoing collaboration between the EEG tech EMRN is essential. Their roles are complementary to each other and enhance safety in the EMU. Results: The EMRN role was initiated at SJHMC in October 2007. Staff members in this role have received specific education regarding the clinical recognition of seizure presentation and novice training on EEG pattern recognition. Early identification of clinical events on the video monitor fosters a rapid response and the probability of an ictal assessment to be performed during the seizure. A comparative analysis occurring from May to December 2009 is investigating seizure identification times. This analysis will look at the identification of both clinical and sub clinical events in the EMU. The results of the analysis will likely support the ongoing development of the EMRN role. Conclusions: The EMRN works a 12-hour shift, observing EEG/video monitors and educating staff as needed. The EMRN observes the EEG tracings and notifies the EEG technician of poor tracings, loose wires, or other concerns. When the EMRN suspects a change in the EEG pattern without clinical findings, the “review button” on the computer is marked for the physician’s further review. When an event is observed, the EMRN directs the patient’s nurse or another available nurse to go immediately to the patient’s bedside. Following a seizure, the EMRN is instrumental in the coordination of patient care, perhaps paging a physician for orders for rescue medications or contacting an EEG technician for repair on any wires that may have been dislodged during the event. The EMRN then reviews the video/EEG tracings with the bedside nurse to identify areas for improvement.