bedside sitter for epilepsy monitoring

Kamitaki BK, Billakota S, Bateman LM, Pack AM, Epilepsy & Behavior, 86(2018):15-18.

Often people with epilepsy are admitted to an epilepsy monitoring unit (EMU) to record seizures or to withdraw or change seizure medicines. EEG (electroencephalograph) monitoring may be done to diagnose seizures and epilepsy, determine the seizure type, and see if a person is able to have epilepsy surgery or a device to treat seizures.

When testing is done in the EMU, people are at risk of injury from falls, head injury, complications from seizures, or seizures that last too long. People with implanted electrodes will have additional risks. People can die from seizures and sudden unexpected death in epilepsy (SUDEP) in the hospital too.

Despite the known risks, safety practices are not the same across all epilepsy centers. Some hospitals may observe and monitor patients with video cameras, heart monitors, and other approaches. Sometimes having a person stay in the room with the patient is needed. This is called continuous observation by use of a ”sitter” – someone who sits with the patient and is able observe for seizures and call the nurse or doctor if the seizure isn’t seen on video.

Studying this area is very hard to do. Safety practices need to be tailored to each person with epilepsy and thus can vary a lot. Yet it’s also important that we learn what works best to keep people safe.

Purpose

The purpose of this study was to compare what happens when people have continous observation with a sitter as compared to those without a person in the room. Information gathered looked at the length of time it took for the nurse to get to the room, as well as if any safety problems occurred.

Description of Study

  • The study looked at results of hospitalizations for 26 adults admitted to an epilepsy center over a 3 year period. Information from people who had intracranial stereotactic EEG (SEEG, implanted eletrodes) was included.
    • 13 people were monitored with the center’s usual protocol of no sitter
    • 13 people had a sitter who was employed by the hospital at their bedside during monitoring
  • Nursing responses to all seizures detected on the EEG or video, and seizure related side effects were examined.

Summary of Study Findings

  • 63 seizures were recorded in the no-sitter group and 53 seizures were recorded in the sitter group
  • The type of seizures recorded did not differ significantly between the two groups.
  • 33% of seizures were missed by the nursing staff in people who did not have a sitter in the room.
  • Only 15% of seizures were missed in the group of people with a full-time sitter present.
  • Nurses got to the people who had a seizure faster if there was a sitter present. Response times averaged 12 to 13 seconds faster than those who did not have a sitter.
  • Two people who did not have a sitter pulled their electrodes out during a seizure (caused by confusion related to the seizure). This did not happen in any people who had a sitter.

What does this mean?

  • This study suggests that nurses respond to seizures faster when they are witnessed or seen on EEG when a full-time sitter is in the room.
  • Getting to a person quickly can help them stay safe and may prevent problems like pulling EEG electrodes out.
  • While this was a small study of only 26 people, it looked at a real-life situation that does not have an agreed upon solution. The use of sitters is considered costly and many hospitals rely on technology to monitor a person’s safety. This study suggests that having a person in the room may be better, at least in high risk situations when a person has implanted electrodes.
  • Future studies are needed to look at costs and safety and to compare in-person versus video monitoring performed by different people (hospital sitters, nurses, EEG technologists, or family members).
  • Future studies might also consider use of wearable seizure detection devices on the EMU as a way to increase safety and improve response to seizures.
  • People with epilepsy and their families should talk to their health care providers before being admitted to an EMU and ask what type of seizure observation is used. If a loved one is at risk for injury, ask if family members can help observe seizures if no sitter is available.

Article published in Epilepsy & Behavior, September 2018.

Authored By: 
Patty Obsorne Shafer RN, MN
Authored Date: 
09/2018
Reviewed By: 
Joseph I. Sirven MD
on: 
Sunday, September 16, 2018