• Critical care nurse · Apr 2022

    Implementing Quantitative Electroencephalogram Monitoring by Nurses in a Pediatric Intensive Care Unit.

    • Erica Prendergast, Michele Grimason Mills, Jonathan Kurz, Joshua Goldstein, and Andrea C Pardo.
    • Erica Prendergast is a pediatric neurocritical care nurse practitioner, Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program at Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois.
    • Crit Care Nurse. 2022 Apr 1; 42 (2): 32-40.

    BackgroundNonconvulsive seizures occur frequently in pediatric intensive care unit patients and can be impossible to detect clinically without electroencephalogram monitoring. Quantitative electroencephalography uses mathematical signal analysis to compress data, monitoring trends over time. Nonneurologists can identify seizures with quantitative electroencephalography, but data on its use in the clinical setting are limited.Local ProblemBedside quantitative electroencephalography was implemented and nurses received education on its use for seizure detection. This quality improvement project aimed to describe the time between nurses' recognition of electrographic seizures and seizure treatment.MethodsEducation was provided in phases over several months. Retrospective medical record review evaluated quantitative electroencephalograms and medication interventions from September 2019 through March 2020. A bedside form was used to measure nurses' use of quantitative electroencephalograms, change recognition, clinician notification, and seizure treatment. A nurse survey evaluated the education after implementation.ResultsData included 44 electroencephalograms from 30 pediatric intensive care unit patients aged 18 years or less with electroencephalogram monitoring durations of 4 hours or longer. Nurses monitored quantitative electroencephalograms in 73% of cases, documented at least 1 change in the quantitative electroencephalogram display in 28% of these cases, and contacted the neurocritical care team in 78% of cases in which they documented a change. Seizure treatment was initiated in response to the nursing call in 1 patient. Time to treatment was approximately 20 minutes.ConclusionsAn education program for quantitative electroencephalogram interpretation by nurse providers is feasible yet complex, requiring multiple reeducation cycles.©2022 American Association of Critical-Care Nurses.

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