Abstracts

Rationale: Patients admitted for video-EEG monitoring should be monitored continuously due to concerns for injury or cardiac/respiratory events caused by seizures (1). For a community hospital, it is a challenge to find the resources to have qualified staff continuously monitor these patients. We hypothesized that cardiac telemetry technologists could be trained to provide video monitoring, and that remote cardiac telemetry would provide an additional layer of safety in monitoring for potentially life-threatening events. Methods: The technologists were given 1 hour of education: explanation of role, when to call the nurse, and were shown video examples of seizures. The technologists were asked to visually check patients on the video monitors once every 5 minutes to ensure that they appeared safe and were not having a generalized tonic-clonic seizure. We surveyed the technologists after 3 months using a 5-point scale to assess: educational needs, expectations, comfort with role, overall EMU safety, and RN responsiveness. We also performed a retrospective review of the medical record and telemetry communication record for all elective patient admissions to the EMU from March 2009 thru March 2010. We collected the following information: cardiac telemetry rhythm and rates, calls from technologists to nursing staff, discharge diagnosis, and consults. Results: The 3 month survey indicated the technologists felt they did not need additional education; most were clear on their expectations and comfortable in their role. Most felt they were contributing to patient safety. They were concerned that RN responsiveness to their calls needed to improve and how to balance other duties. Nurses were called for: 12 suspected seizures, sometimes assisted by cardiac rhythm changes; 10 episodes of unsafe behavior; and 24 episodes of being off camera without notification. There were 2 patient falls, but neither patient was on camera. Fifty-one patients were electively admitted to the EMU. Sixteen patients (31.4%) were found to have significant rate or rhythm changes. 3 of these patients had complex partial or simple partial seizures, 7 patients had non-epileptic events (including primary cardiac events), 3 patients had both epilepsy and non-epileptic events, and 3 patients had no clinical events. Five patients had ictal tachycardia (9.8%), which triggered calls to nursing staff that alerted them to seizure onset. Cardiology consultation was obtained on 4 patients. Conclusions: Using concomitant cardiac telemetry monitoring has successfully contributed to patient safety in the epilepsy monitoring unit. Technologists were successfully trained in simple video assessment for safe vs. unsafe behavior. Remote cardiac telemetry allowed the detection of ictal arrhythmias in real time, prompting immediate assessment by nursing staff, and at times alerted nursing staff to the onset of a seizure prior to other clinical signs. 1) Noe KH, Drazkowski JF 2009. Safety of long-term video-electroencephalographic monitoring for evaluation of epilepsy. Mayo Clin Proc 84(6):495-500.