Date of Award

Spring 5-1-2022

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Joy Shoemaker

First Committee Member

Amy Hotler

Second Committee Member

Angela Parsons


Seizure, Safety, Epilepsy Monitoring Unit, Identifying Practice Gaps, Retrospective Chart Review, Chart Audit

Subject Categories

Diseases | Medicine and Health Sciences | Neurology | Neurosciences | Nursing | Other Medical Sciences


Long-term video-electroencephalography (EEG) monitoring in the epilepsy monitoring unit (EMU) is an elective procedure and generally safe. Clinical experts determined the EMU protocols at a level-4 comprehensive epilepsy center were not followed correctly. The project is a retrospective chart audit incorporating Ray’s Bureaucratic Caring theoretical framework with Donabedian’s conceptual model. The project objective is to evaluate if safety measures protocols are implemented appropriately in the EMU and determine whether a need exists for quality improvements.

The project reviewed patients admitted to the EMU from September 2021 through November 2021 who developed a generalized tonic clonic (GTCs) seizure with electrographic epileptiform correlation. Data abstractors collected seizure safety indicators from eleven patients with fifteen GTCs. Of the fifteen GTCs, the seizure safety efficiency indicator revealed an average GTC was 92.7 seconds, and the time to responder response was 43.6 seconds. The GTC management and seizure precaution indicators showed (53%) had suction set up, (60%) suction initiated, (67%) vital signs recognized, (53%) no one called out vital signs, (40%) vital signs obtained, (60%) variation of a neurological assessment, (13%) of patients turned on their side, and (80%) had no objects to cause injury. Other indicators include (93%) had four side-rails up, (100%) no one called out bed in the low position, (13%) had continuous pulse oximetry, and (80%) had IV access and continuous telemetry. Interventions to stop seizure indicators include (67%) no one called out Ativan administration, (60%) no one called out notifying physician. During the postictal stage, (87%) variation of a neurological assessment, (73%) variation of vital signs, and (80%) postictal suctioning occurred. Medication change indicator revealed (80%) of antileptic drugs (AEDs) stopped and (20%) on AEDs. Of the fifteen GTCs, two GTCs, no one responded.

The project identified practice gaps in all seizure safety indicators, necessitating further investigation. Performance improvement efforts or quality improvement initiatives to lower EMU-related seizure emergencies, injuries, adverse events, and fatalities should be employed to prevent seizure safety concerns during an EMU evaluation.

Licensing Permission

Copyright, all rights reserved. Fair Use

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