We employed a QI project based on Lean Methodology. Our SMART goal was to increase complete seizure first aid and neurologic assessment from 40% to 80% in patients admitted to Lucile Packard Children’s Hospital (LPCH) EMU for phase 1 monitoring by February 2019. Bedside care of seizing patients was determined by review of individual video EEG records.

We developed a bedside seizure management protocol based on the National Association of Epilepsy Centers guidelines. Over six months, bedside providers were taught the protocol through developed educational and multimedia campaigns. Primary outcome - completed seizure first aid and neurologic assessment; process measure - use of protocol; secondary measures - time to seizure first aid and neurologic assessment; balancing measure – nursing perceived effectiveness in caring for seizures.

From Nov 2017-Feb 2019, all video EEGs for patients admitted for Phase 1 studies were examined with full review of events in which nursing was notified, pre-intervention (n=12) and post intervention (n=10). Complete seizure first aid increased from 42% to 90% (p=0.03). A complete, relevant neurologic assessment increased from 17% to 90% (p=0.003). The protocol was followed in 90% of all seizures. On average it took 3 min to begin to obtain vital signs and 3.3 minutes to begin neurologic assessment which decreased to 1.2 min (p=0.02) and 1.6m (p=0.03) respectively. Nursing perceived care effectiveness increased from 29% to 51%.