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.
Michele Grimason Mills is a neurocritical care nurse practitioner, Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program at Ann & Robert H. Lurie Children's Hospital of Chicago.
Crit Care Nurse. 2022 Apr 1;42(2):32-40. doi: 10.4037/ccn2022680.
Nonconvulsive 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.
Bedside 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.
Education 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.
Data 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.
An education program for quantitative electroencephalogram interpretation by nurse providers is feasible yet complex, requiring multiple reeducation cycles.
非惊厥性发作在儿科重症监护病房患者中很常见，如果没有脑电图监测，临床上可能无法检测到。定量脑电图使用数学信号分析来压缩数据，监测随时间的趋势。非神经科医生可以使用定量脑电图识别发作，但关于其在临床环境中应用的数据有限。
床边定量脑电图已实施，护士接受了用于检测发作的使用培训。这项质量改进项目旨在描述护士识别脑电图发作与开始治疗之间的时间。
教育分几个月进行几个阶段。回顾性病历评估了 2019 年 9 月至 2020 年 3 月期间的定量脑电图和药物干预。床边表格用于测量护士使用定量脑电图、变化识别、通知临床医生和开始治疗的情况。护士调查评估了实施后的教育情况。
数据包括 30 名 18 岁或以下儿科重症监护病房患者的 44 份脑电图，脑电图监测时间为 4 小时或更长。护士在 73%的病例中监测定量脑电图，在这些病例中的 28%记录了至少 1 次定量脑电图显示的变化，并在记录到变化的 78%的病例中联系了神经危重病护理团队。根据护士的呼叫，对 1 名患者开始了癫痫治疗。治疗时间约为 20 分钟。
对护士提供者进行定量脑电图解释的教育计划是可行的，但很复杂，需要多次再教育循环。
