Doctor of Nursing Practice (DNP) Projects
Access Control
Campus Access
Degree Program
Doctor of Nursing Practice
Degree Track
Post Master's DNP Completion
Year Degree Awarded
2021
DOI
https://doi.org/10.7275/22717308
Month Degree Awarded
May
Keywords
Electroencephalogram, EEG, non-convulsive seizures, status epilepticus
Advisor
Dr. Terrie Black
DNP Project Chair
Dr. Terrie Black
DNP Project Outside Member Name
Dr. Parshaw Dorriz, Dr. Jennifer Cord, Dr. Diane Drake, Mary Kay Bader
Abstract
Background: Non-convulsive seizures require emergent recognition and treatment to reduce the risk of neurological decline, and associated morbidity and mortality. Current evidence indicates that up to 27% of hospitalized patients experience seizures, and nearly one-third are non-convulsive, and as a result, diagnosis is often missed or delayed, placing patients at risk of preventable harm. Purpose: The project intended to increase nursing knowledge on seizures and the use of advanced technology on a portable electroencephalogram (EEG) device in critical care. Translation of new knowledge and technology into practice sought to elevate the nursing role in seizure management by impacting placement, monitoring, and detection of seizures at the bedside and improve patient outcomes. Methods: An online learning module on seizures and portable EEG technology was provided to critical care nurses with pre and post-tests to determine comprehension of knowledge gained. Integration of knowledge into practice was evaluated with data obtained from de-identified medical records of 92 patients admitted to the ICU and requiring EEG monitoring during the seven month project period. Metrics evaluated included EEG utilization, seizure detection, diagnosis and correlation to neurological outcome and length of stay. Results: A 30% increase in nursing knowledge was achieved with 64 critical care nurses. Using a portable EEG device, that nurses are able to apply at the bedside, demonstrated a substantial reduction in mean time to initiate EEG monitoring of 55 minutes compared to 423 minutes for a conventional 10-20 EEG monitoring system, with faster time from order to diagnosis, from six minutes with a mean of 12.8 hours, compared to a mean 30.1 hours for conventional EEG. ICU length of stay was reduced by a mean of 1.8 days when the Ceribell portable EEG device was used. Conclusion: Integration of knowledge and new EEG technology in an intensive care unit during under-resourced pandemic conditions did not fully translate into nursing practice or demonstrate statistically significant changes in patient outcomes, but opportunities to improve the nursing process in EEG monitoring and seizure detection, to improve seizure management and patient safety were identified for further quality improvement.
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