Implementation of a New Clinical Testing Tool to Assess Patients During Ictal and Postictal Periods

Abstract

BACKGROUND: A seizure is a sudden, uncontrolled electrical disturbance of the cortical neurons in the brain, which can cause changes in behavior, movements, feelings, and consciousness. Clinical signs and symptoms before, during, and after a seizure can help to determine the seizure onset. The use of standardized clinical testing tools has been reported as being valuable, although also challenging, by some institutions. This study investigated the effectiveness of implementing a new clinical testing tool designed with an emphasis on simplicity for use during and after seizures. METHODS: A pre-and-post evaluation study was conducted from January 2020 to November 2020 in the epilepsy monitoring unit/neurology unit at a hospital in Sydney, Australia. The primary outcome of interest was the incidence of clinical testing during seizures. The secondary outcome of interest was nurse knowledge about clinical testing during a seizure. This knowledge was measured via testing before and after clinical education sessions. The third outcome of interest was nurse confidence regarding the use of the clinical testing tool. The confidence level was measured via posteducation session follow-up surveying. RESULTS: Forty-seven nursing staff (10 neurophysiology nurse technologists and 37 neurology unit nurses) participated in the education program. Forty-four seizures were evaluated. Clinical testing during ictal and postictal periods was performed by nursing staff 82% of the time during 2020, compared with 67% during the 2018 to 2019 preeducation comparison period. This difference was not statistically significant, but it was clinically relevant (P = .07). In addition, the time from seizure alarm to clinical testing improved significantly from a median of 30.5 seconds in 2018 to 2019 to 14 seconds in 2020 (P < .001). CONCLUSION: The tool is easy and convenient for nursing staff to perform clinical examinations accurately during ictal and postictal periods.

Length of Stay Does Not Predict Change in Epilepsy Monitoring Unit Comfort Questionnaire Scores

“…Whereas a seizure is an uncontrolled cortical electrical event in the brain, epilepsy is the disorder that leads to seizure. 3 Patients' uncertainty and lack of seizure control may alter how they view their epilepsy. 11 However, few studies have evaluated the correlation between patient stress, comfort, and EMU length of stay (LoS).…”

“…1 Patients are admitted to the EMU for evaluation of seizure origin and factors contributing to their seizures, as well as adjust treatment regimens that will enhance the patient's quality of life. 2,3 In the EMU, patients have the possibility to identify factors that increase their risk for seizure; identifying these risks may allow patients to make lifestyle adjustments that may minimize seizure frequency and severity. 4,5 The EMU teams provided seizure monitoring using continuous electroencephalogram, as well as video and audio monitoring.…”