Implementing Quantitative Electroencephalogram Monitoring by Nurses in a Pediatric Intensive Care Unit

BACKGROUND Nonconvulsive seizures occur frequently in pediatric intensive care unit patients and can be impossible to detect clinically without electroencephalogram monitoring. Quantitative electroenceph-alography uses mathematical signal analysis to compress data, monitoring trends over time. Nonneurolo-gists can identify seizures with quantitative electroencephalography, but data on its use in the clinical setting are limited. LOCAl PROBLEM 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. METHODS 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. RESULTS 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. CONCLUSIONS An education program for quantitative electroencephalogram interpretation by nurse pro-viders is feasible yet complex, requiring multiple reeducation cycles.