Continuous Electroencephalographic Training for Neuroscience Intensive Care Unit Nurses: A Feasibility Study.
Journal
The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
ISSN: 1945-2810
Titre abrégé: J Neurosci Nurs
Pays: United States
ID NLM: 8603596
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
pubmed:
3
8
2020
medline:
6
5
2021
entrez:
3
8
2020
Statut:
ppublish
Résumé
Use of continuous electroencephalographic (cEEG) monitoring has more than doubled at our institution for the last 4 years. Although intensive care unit cEEG is reviewed remotely by board-certified epileptologists every 4 to 6 hours, there are inherent delays between occurrence, recognition, and treatment of epileptiform activity. Neuroscience intensive care unit (NSICU) nurses are uniquely positioned to monitor cEEG in real time yet do not receive formal training. The purpose of this study was to evaluate the effectiveness of an education program to teach nurses to monitor cEEG, identify a burst suppression pattern, and measure the duration of suppression. We performed a retrospective analysis of pretest and posttest data. All NSICU nurses (40) were invited to complete the pretest (PT-0), with 25 participating. Learning style/preference, demographics, comfort with cEEG, and knowledge of EEG fundamentals were assessed. A convenience cohort of NSICU nurses (13) were selected to undergo EEG training. Posttests evaluating EEG fundamental knowledge were completed immediately after training (PT-1), at 3 months (PT-3), and at 6 months (PT-6). The cohort also completed a burst suppression module after the training, which assessed ability to quantify the duration of suppression. Mean cohort test scores significantly improved after the training (P < .001). All nurses showed improvement in test scores, and 76.9% passed PT-1 (a score of 80% or higher). Reported mean comfort level with EEG also significantly improved after the training (P = .001). There was no significant difference between mean cohort scores between PT-1, PT-3, and PT-6 (all 88.6%; P = 1.000). Mean cohort score from the bust suppression module was 73%, with test scores ranging from 31% to 93%. NSICU nurses can be taught fundamentals of cEEG, to identify a burst suppression pattern, and to quantify the duration of suppression. Further research is needed to determine whether this knowledge can be translated into clinical competency and affect patient care.
Sections du résumé
BACKGROUND
BACKGROUND
Use of continuous electroencephalographic (cEEG) monitoring has more than doubled at our institution for the last 4 years. Although intensive care unit cEEG is reviewed remotely by board-certified epileptologists every 4 to 6 hours, there are inherent delays between occurrence, recognition, and treatment of epileptiform activity. Neuroscience intensive care unit (NSICU) nurses are uniquely positioned to monitor cEEG in real time yet do not receive formal training. The purpose of this study was to evaluate the effectiveness of an education program to teach nurses to monitor cEEG, identify a burst suppression pattern, and measure the duration of suppression.
METHODS
METHODS
We performed a retrospective analysis of pretest and posttest data. All NSICU nurses (40) were invited to complete the pretest (PT-0), with 25 participating. Learning style/preference, demographics, comfort with cEEG, and knowledge of EEG fundamentals were assessed. A convenience cohort of NSICU nurses (13) were selected to undergo EEG training. Posttests evaluating EEG fundamental knowledge were completed immediately after training (PT-1), at 3 months (PT-3), and at 6 months (PT-6). The cohort also completed a burst suppression module after the training, which assessed ability to quantify the duration of suppression.
RESULTS
RESULTS
Mean cohort test scores significantly improved after the training (P < .001). All nurses showed improvement in test scores, and 76.9% passed PT-1 (a score of 80% or higher). Reported mean comfort level with EEG also significantly improved after the training (P = .001). There was no significant difference between mean cohort scores between PT-1, PT-3, and PT-6 (all 88.6%; P = 1.000). Mean cohort score from the bust suppression module was 73%, with test scores ranging from 31% to 93%.
CONCLUSIONS
CONCLUSIONS
NSICU nurses can be taught fundamentals of cEEG, to identify a burst suppression pattern, and to quantify the duration of suppression. Further research is needed to determine whether this knowledge can be translated into clinical competency and affect patient care.
Identifiants
pubmed: 32740316
doi: 10.1097/JNN.0000000000000535
pii: 01376517-202010000-00010
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
245-250Références
Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015;32(2):87–95.
Le Roux P, Menon DK, Citerio G, et al. Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Neurocrit Care. 2014;21(suppl 2):S1–S26.
Kennedy JD, Gerard EE. Continuous EEG monitoring in the intensive care unit. Curr Neurol Neurosci Rep. 2012;12(4):419–428.
Young GB, Mantia J. Continuous EEG monitoring in the intensive care unit. Handb Clin Neurol. 2017;140:107–116.
Schomer AC, Hanafy K. Neuromonitoring in the ICU. Int Anesthesiol Clin. 2015;53(1):107–122.
Vespa PM, Nuwer MR, Nenov V, et al. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg. 1999;91(5):750–760.
Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part II: personnel, technical specifications, and clinical practice. J Clin Neurophysiol. 2015;32(2):96–108.
Gavvala J, Abend N, LaRoche S, et al. Continuous EEG monitoring: a survey of neurophysiologists and neurointensivists. Epilepsia. 2014;55(11):1864–1871.
Arbour RB, Dissin J. Predictive value of the bispectral index for burst suppression on diagnostic electroencephalogram during drug-induced coma. J Neurosci Nurs. 2015;47(2):113–122.
Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002;43(2):146–153.
Winer JW, Rosenwasser RH, Jimenez F. Electroencephalographic activity and serum and cerebrospinal fluid pentobarbital levels in determining the therapeutic end point during barbiturate coma. Neurosurgery. 1991;29(5):739–741.
Olson DM, McNett MM, Livesay S, Le Roux PD, Suarez JI, Bautista C. Neurocritical care nursing research priorities. Neurocrit Care. 2012;16(1):55–62.
Seiler L, Fields J, Peach E, Zwerin S, Savage C. The effectiveness of a staff education program on the use of continuous EEG with patients in neuroscience intensive care units. J Neurosci Nurs. 2012;44(2):E1–E5.
Whitelaw A, White RD. Training neonatal staff in recording and reporting continuous electroencephalography. Clin Perinatol. 2006;33(3):667–677.
Amorim E, Williamson CA, Moura L, et al. Performance of spectrogram-based seizure identification of adult EEGs by critical care nurses and neurophysiologists. J Clin Neurophysiol. 2017;34(4):359–364.
Dericioglu N, Yetim E, Bas DF, et al. Non-expert use of quantitative EEG displays for seizure identification in the adult neuro-intensive care unit. Epilepsy Res. 2015;109:48–56.
Kang JH, Sherill GC, Sinha SR, Swisher CB. A trial of real-time electrographic seizure detection by neuro-ICU nurses using a panel of quantitative EEG trends. Neurocrit Care. 2019;31(2):312–320.
Kramer AH, Kromm J. Quantitative continuous EEG: bridging the gap between the ICU bedside and the EEG interpreter. Neurocrit Care. 2019;30(3):499–504.
Lalgudi Ganesan S, Stewart CP, Atenafu EG, et al. Seizure identification by critical care providers using quantitative electroencephalography. Crit Care Med. 2018;46(12):e1105–e1111.
Swisher CB, White CR, Mace BE, et al. Diagnostic accuracy of electrographic seizure detection by neurophysiologists and non-neurophysiologists in the adult ICU using a panel of quantitative EEG trends. J Clin Neurophysiol. 2015;32(4):324–330.
Topjian AA, Fry M, Jawad AF, et al. Detection of electrographic seizures by critical care providers using color density spectral array after cardiac arrest is feasible. Pediatr Crit Care Med. 2015;16(5):461–467.
Parvizi J, Gururangan K, Razavi B, Chafe C. Detecting silent seizures by their sound. Epilepsia. 2018;59(4):877–884.
Yazbeck M, Sra P, Parvizi J. Rapid response electroencephalography for urgent evaluation of patients in community hospital intensive care practice. J Neurosci Nurs. 2019;51(6):308–312.