Andrew Quinn, INBRE Nursing Research Fellow, University of New Hampshire

1. Continuous Pulse Oximetry Monitoring System Compared to Standard Seizure Alarms: A Descriptive Study Andrew Quinn, INBRE Nursing Research Fellow, University of New Hampshire Karen Secore MS, APRN, CNRN; Mary Jo Slattery MS, RN, Dartmouth-Hitchcock Medical Center Continuous Pulse Oximetry: Standard Seizure Alarms: Encephalogram (EEG) monitoring includes the use of Grass- Telefactor seizure alarms. This alarm is activated by: • Brain waves for seizure activity over 30 second periods. • The shape and duration of EEG spikes to discern seizure activity from extraneous artifacts. CONCLUSIONS BACKGROUND The continuous pulse oximetry system was 18 seconds faster (on average) in identifying generalized seizures than the standard seizure alarm. Nurses were more likely to intervene for generalized seizures than for complex partial seizures. The most prevalent interventions for seizures were supplemental oxygen therapy, oral suctioning, and repositioning. Nurses alerted to a generalized seizure by a pulse oximetry unit were more likely to suction or reposition a patient. This study provides a foundation for the development of a epilepsy specific, continuous pulse oximetry system protocol. The Masimo Patient SafetyNet™ system provides continuous pulse oximetry monitoring • The device measures heart rate and oxygen saturation levels. It is secured around the patient’s finger, and triggers an audible alarm or a nurse pager. • The unit uses second-by-second monitoring to display and record patient vital signs. Epilepsy is a neurological condition in the brain that causes recurrent seizures. Manifestations of seizures can vary including generalized convulsions, abnormal movement, or staring spells. In order to characterize patients’ seizures and identify treatment options, epilepsy patients are admitted to a comprehensive epilepsy monitoring unit. There patients are often taken off their antiepileptic medications to provoke seizures. This poses a safety risk related to respiratory and cardiac function and causes a potential for injury. Ictal hypoxemia may contribute to sudden unexplained death in epilepsy patients.   Continuous pulse oximetry monitoring using The Patient SafetyNet™ system (Masimo) was implemented on an epilepsy unit after a successful trial on the inpatient surgery units. The efficacy of continuous pulse oximetry monitoring is unknown in epileptic patients. Results Demographics (n=43) Frequency of Seizure Types CLINICAL IMPLICATIONS • Continuous pulse oximetry is an effective monitoring device for the epilepsy patient population that identifies generalized seizures faster than EEG seizure monitoring. • It acts as a reminder to nurses for airway protection (suction/reposition). • As generalized seizures are more common on the unit, continuous pulse oximetry monitoring can improve overall nurse response time to seizures. • Tighter parameters to decrease RN alarm fatigue must be established. PURPOSE • Describe nursing interventions related to seizure activity on an epilepsy monitoring unit. • Compare standard EEG video monitoring with continuous pulse oximetry monitoring in: • identification of seizure events • identify what first alerts the nurse to a seizure • the use of oxygen and other therapeutic modalities • Describe the effectiveness of continuous pulse oximetry in the epilepsy population LIMITATIONS Standard practice variability due to the lack of a seizure protocol. Alarm fatigue due to the high level of false positive readings with continuous pulse oximetry can result in a delay by nurses to answer alarms promptly. Challenges with accessing the archived second-by-second continuous pulse oximetry data limited the scope of this project. METHODS [Not typically associated with significant oxygen desaturation] Quality improvement methods Descriptive Study Retrospective review of patients’ EEG videos and electronic medical records Investigator developed staff nurse survey ACKNOWLEDGEMENTS Special Thanks to: Marie Bakitas DNSc, APRN, FAAN and Charles Wise for their support and guidance throughout the research process. The Summer Undergraduate Research Fellowship Program in Nursing is supported by the New Hampshire IDeA Network of Biological Research Excellence (NH-INBRE) with grants from the National Center for Research Resources (5P20RR030360-03) and the National Institute of General Medical Sciences (8P20GM103506-03), National Institutes of Health.