Sch seizure precautions

1. Seizure Precautions Recommendations Based on Literature Reviewed Haley Johnson, Ann Kunstleben, Andrea Nyquist, & Megan Zimmer

2. Approximately 10% of Americans will experience a single, unprovoked seizure. In the United States, the prevalence of epilepsy increases with age and is estimated to affect 2.7 million Americans. American Association of Neuroscience Nurses, 2009

3. Introduction These recommendations are intended to identify patients who are at risk for a seizure and outline safety precautions to maintain a patent airway and prevent injury in the event of a seizure.

4. Review of Evidence-Based Literature A literature review was conducted using the following search terms: seizure, nursing seizure precautions, risk, environmental safety, padded side rail, and epilepsy. Search databases included Medline, ScienceDirect, CINAHL Plus, and PubMed . Combining the terms seizure, risk, injury, nursing, epilepsy, precaution, and prevention revealed no research articles, one professional association guideline (Level D ), and eight expert opinion journal articles (Level E ). These are assigned levels of evidence when compared to the American Association of Critical Nurse (AACN) levels of evidence . Another search of the aforementioned databases was performed using the search terms pad, side rail, injury, seizure, precaution, prevention, and epilepsy. Lack of primary research results for use of padded side rails to prevent patient injury demonstrated a lack of strong research in this area .

5. Evidence Schema The evidence leveling system used was AACN New Levels of Evidence (Armola et al., 2009 ): Level A- Meta-analysis of multiple controlled studies or meta-synthesis of qualitative studies with results that consistently support a specific action, intervention or treatment Level B- Well designed controlled studies, both randomized and nonrandomized, with results that consistently support a specific action, intervention, or treatment Level C- Qualitative studies, descriptive or correlational studies, integrative reviews, systematic reviews, or randomized controlled trials with inconsistent results Level D- Peer-reviewed professional organizational standards, with clinical studies to support recommendations Level E- Theory-based evidence from expert opinion or multiple case reports Level M- Manufacturers’ recommendations only

6. Recommendations

7. Risk Assessment Nurse will assess for risk of seizure: History of seizures (note frequency, classification, and sequence of events leading to seizure) O n a seizure medication (level of adherence to medication regimen) H istory of brain injury Other conditions such as head trauma, stroke, preeclampsia, central nervous system condition, and drug/alcohol withdrawal. If risk is present, notify physician to consider an order for seizure precautions ( Buelow , 2013; Clore 2010; Ignatavicius & Workman, 2013; Smith & Caple , 2011; Caple & Schub , 2011)

8. Environmental Safety If risk of seizure is present, the nurse will assess the environment for potential sources for injury: Look for sharp objects including pens and pencils Keep bed in low position Loosen tight clothing, especially around the neck Consider removing excess furniture from the immediate patient care area ( Buelow , 2013; Fisher & Long, 2009 ; Hussey, 2012; Ignatavicius & Workman, 2013; Smith & Caple, 2011; Caple & Schub, 2011)

9. Airway Protection To assure for maintenance of a patent airway: Again, loosen restrictive clothing around the patient’s neck and chest Suction equipment available, in the room, and fully functional Oxygen source and delivery device in the patient's room Oral airway at bedside, hanging at the head of bed for easy access ( Buelow , 2013; Clore 2010; Hussey, 2012; Ignatavicius & Workman, 2013; Smith & Caple , 2011; Caple & Schub , 2011)

10. Safety To protect the patient from injury: Identification of patient risk (magnet or sign outside of room, wrist band, communication to patient care staff [including comment in transport flow sheet or ticket to ride]) Educate the patient/family on reasons for seizure precautions, need to maintain precautions for duration of admission, and to notify staff if an aura or seizure is experienced. Side rails padded and raised* F loor padding A ntiepileptic drug (AED) treatment if necessary. *Recent literature review is inconclusive if side rail padding prevents injury during seizure activity ( Buelow , 2013; Clore 2010; Hussey, 2012; Smith & Caple , 2011; Caple & Schub , 2011)

11. Room Signage To accommodate to the St. Cloud Hospital’s existing signage methods, it is recommended that a magnet be created to identify those placed on seizure precautions.

12. Follow Up Thorough documentation in Epic, including patient assessment and risk, date and time seizure precautions were implemented, any complications or unexpected events, interventions performed, and all patient and family education completed. Education for the patient and family with a focus on prevention of seizures, medication regimen, and patient safety. Consider providing a patient education handout about seizure precautions. Additional educational key points may vary based on seizure etiology. ( Buelow , 2013; Clore 2010; Fisher & Long, 2009; Hussey, 2012; Ignatavicius & Workman, 2013 ; Smith & Caple , 2011; Caple & Schub , 2011 )

13. Questions?

14. References Armola , R. R., Bourgault , A. M., Halm , M. A., Board, R. M., Bucher, L., Harrington, L., … Medina, J. (2009). AACN levels of evidence: What’s new? Critical Care Nurse, 29, 70-73. Buelow , J. M. (2013). Kathleen Mears memorial lecture: An update on patient safety issues in the epilepsy monitoring unit. Neurodiagnostic Journal , 53(2), 104-113. Caple, C., & Schub, E. (2011). Skill competency checklist: Seizure precautions in adults: Initiating and maintaining. Glendale, CA: Cinahl Information Systems. Caple, C., & Smith, N. (2011). Nursing practice and skill: Seizure precautions in adults: Initiating and maintaining. Glendale, CA: Cinahl Information Systems. Clore, E. T. (2010). Seizure precautions for pediatric bedside nurses. Pediatric Nursing, 36(4), 191-194. Epilepsy Foundation. (2010). First aid for seizures (convulsive, generalized tonic- clonic , grand mal). Retrieved from http :// epilepsy.prod.acquiasites.com/sites/core/files/atoms/files / SeizureFirstAid_Page1.pdf Fisher, R., & Long, L. (2009). Care of the patient with seizures. Retrieved from http://www.aann.org/pdf/cpgaannseizures.pdf Hussey, L. (2012). Nursing care before, during, and after a seizure. Retrieved from http://www.mosbysnursingconsult.com/nursing/clinical-updates/full-text?clinical_update _id= 190223 Ignatavicius, D.D., & Workman, M.L. (2013). Medical surgical nursing: Patient-centered collaborative care (7th ed.). St. Louis, MO: Elsevier Saunders.