Table 2.

Components of the Intensive Care Unit Continuous EEG Monitoring Pathway Implementation.

Multi-disciplinary Team Development Team composed of Electroencephalographers (2), Neurology physicians providing care on the Critical Care Neurology Consultation service (2), Critical Care Medicine physician (1), EEG technologists (2), ICU nurses (1), ICU pharmacist (1), quality improvement specialist physician (1), and quality improvement analyst (1). Team bounded by specific and stable membership, scheduled meetings, unified goal, and timeline. Mandate provided since official institutional quality improvement project.

Staff Education Establishment of multi-disciplinary standards for EEG monitoring indications, communication strategies, and management strategies. Grand Rounds lectures for critical care medicine and neurology services. Resident and Fellow educational lectures for neurology and critical care medicine during summer (as new trainees begin). Discussion of related cases in Multi-Disciplinary Case Management Conferences. Bedside teaching for ICU nurses by nurse education team. Lectures and case discussions for EEG technologists in EEG Review Conference.

Daily Workflow Modifications Single easily accessible pathway document guiding care for all involved staff. EEG monitoring initiation based on critical care medicine recognition of EEG monitoring indication and subsequent order, rather than required neurologic consultation. Revised EEG monitoring order in electronic medical record which incorporated related nursing orders addressing button pushes to mark events and medication administration times and additional point-of-care educational materials. Levetiracetam provided in ICU Pyxis allowing for more rapid administration since it didn’t need to be delivered from pharmacy. Just-in-time education for ICU nurses caring for patients undergoing EEG monitoring provided by EEG Technologists using a jointly developed brief paper education book. New EEG equipment button pads allowing easier bedside documentation of events and medication administrations by ICU nurses by a single button push. Enhanced role for EEG Technologists in screening for seizures and communicating data regarding seizures based on The American Society of Electroneurodiagnostic Technologist’s “National Competency Skill Standards for ICU/cEEG Monitoring” which provides for roles in clinical staff education regarding EEG monitoring and communication of convulsive and electrographic seizure event data to encephalographers and other clinicians.40 Prior to pathway initiation these roles were not converted into standardized institutional standards and EEG technologists had varying understanding of their job expectations and appropriate bounds of practice. After pathway initiation, EEG Technologists received extensive education to ensure they were capable of performing these roles and also understood that these roles were within appropriate practice bounds. Involvement of EEG technologists in results communication to critical care medicine fellows. Unified contact numbers for critical care medicine fellow teams provided at EEG monitoring initiation. Removal of some trainee physicians (pediatrics residents rotating in the pediatric intensive care unit) from the communication workflow despite a recognized small reduction in educational experience. Simplified Citrix-based remote EEG access for EEG attending physicians.