title: A consensus-based approach to patient safety in epilepsy monitoring units: recommendations for preferred practices.
abstract: Patients in an epilepsy monitoring unit (EMU) with video-EEG telemetry have a risk for seizure emergencies, injuries and adverse events, which emphasizes the need for strategies to prevent avoidable harm. An expert consensus process was used to establish recommendations for patient safety in EMUs. Workgroups analyzed literature and expert opinion regarding seizure observation, seizure provocation, acute seizures, and activity/environment. A Delphi methodology was used to establish consensus for items submitted by these workgroups. Fifty-three items reached consensus and were organized into 30 recommendations. High levels of agreement were noted for items pertaining to orientation, training, communication, seizure precautions, individualized plans, and patient/family education. It was agreed that seizure observation should include direct observation or use of closed-circuit camera. The use of continuous observation was strongest in patients with invasive electrodes, at high risk for injury, or undergoing AED withdrawal. This process provides a first step in establishing EMU safety practices.
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Neurology, Boston, MA 02215, USA. poshafer@bidmc.harvard.edu
authors.forename: Patricia O
authors.initials: PO
authors.lastname: Shafer
authors.forename: Janice M
authors.initials: JM
authors.lastname: Buelow
authors.forename: Katherine
authors.initials: K
authors.lastname: Noe
authors.forename: Ruth
authors.initials: R
authors.lastname: Shinnar
authors.forename: Sandra
authors.initials: S
authors.lastname: Dewar
authors.forename: Paul M
authors.initials: PM
authors.lastname: Levisohn
authors.forename: Patricia
authors.initials: P
authors.lastname: Dean
authors.forename: David
authors.initials: D
authors.lastname: Ficker
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Barkley
mesh_terms: D032921:Consensus; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards; D061214:Patient Safety / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies