Evaluation of an algorithm for treatment of status epilepticus in adult patients undergoing video/EEG monitoring.

Abstract

Convulsive or generalized tonic clonic status epilepticus (SE) is a neurological emergency that can lead to transient or permanent brain damage or even death. An algorithm was designed to aid nursing and medical staff members in decision making about the type of SE and pharmacological intervention needed to stop prolonged or repetitive seizures. Fifteen registered nurses at a northern New England medical center's epilepsy unit participated in educational sessions on classification of seizures and status epilepticus prior to use of the algorithm. A pretest-posttest design with an investigator-developed tool was used to measure SE knowledge before and after educational intervention. There was a significant improvement in scores on the posttest of the classification of status epilepticus (Z = -2.93, p = .003). Twenty-nine medical records of patients who had experienced SE between February 1992 and December 1997 were reviewed. Nineteen patients experienced SE before the algorithm was implemented, and 10 patients experienced SE after the algorithm was implemented. A total of 16 patients experienced generalized convulsive SE with 12 episodes occurring before and 4 episodes after algorithm implementation. The mean time taken to stop the episode of SE after pharmacologic treatment began was compared in both groups using a t-test. The mean difference between the groups was 235 minutes (t = 2.57, p = .026). The findings of this project demonstrate that combining a treatment algorithm with education of staff members on its use has benefits in the practice setting of an inpatient comprehensive epilepsy program. Episodes of SE are more accurately classified and successful treatment of the episodes occurs earlier.