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Patient Safety Is the Focus of Epilepsy Monitoring Units

The symposium, “Expert Consensus Process on Patient Safety in the Epilepsy Monitoring Unit,” featured a discussion on AES research taken from the last two years, which initially featured sending out a survey to evaluate patient care and safety issues in EMUs. The results demonstrated that there is “a need for the creation of standards in patient care and safety measures in epilepsy monitoring units (EMUs) across the United States.”

Upon compiling the survey results, lead researchers decided to create four workgroup because they found that there was a need for recommendations on how to improve patient safety within the EMU.

Seizure Provocation Group

This group reviewed the types of seizure provocations, AED withdrawal, and behavioral and psychiatric issues. There is not a lot of available research, but they recommended the need to develop evidence-based information for practice.

Acute Seizure Management Group
The focus of this group was on communication and education, patient admission history, and postictal safety. The issue of communication errors leading to medical errors was once again emphasized during the discussion. This group recommended the need to improve written and/or electronic forms, create a model for structured communication, and set up teamwork training. They also stressed the importance of properly educating the epilepsy team, which is extremely important.

Seizure Observation Group
The presenters admitted that they had some difficulty in making recommendations because there is not a lot of literature on seizure observation. Although this was the case, they were able to come up with a couple of suggestions:
• All adverse events and falls cannot be controlled, so the workgroup recommends implementing observation plans and stress the need for better treatment plans.
• Expert observers are not always available, so EMUs need to figure out a way to set up acceptable plans.
• Late-night staff might be as capable, so there is a need to address how to fix this.

Activity and Environment Group

This group evaluated EMU safety to avoid injury and cormorbidities and that EMUs should create a daily checklist speaking to patient safety and make the design of each unit safer. They also recommended the importance of providing appropriate admission and discharge education for patient and families. Regarding the design of EMUs, the focus was on making adjustments for patient safety in the bathrooms, especially since patients want to maintain some independence and do not want to ask for assistance when going to the bathroom. Some of solutions they suggested include using soft toilet seats, safer flooring, and if absolutely needed, nurses could lock to bathroom door from the outside.

"In the continuum of patient care, EMUs are critically important and can significantly drive outcomes," said EMU Study Group member Gregory L. Barkley, MD, Clinical Vice Chair, Department of Neurology, Henry Ford Hospital. "This is why the AES has made it a priority to examine EMUs and formulate best practices and guidelines that will establish a standard, increase efficiency and, most importantly, improve patient outcomes."

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