Table 2.
Skill items before and after the test, n (%)
| Skill | Pre-training | Post-training | P (pre-post) |
|---|---|---|---|
| Evaluating the patient (before the patient has witnessed a seizure) | |||
| Obtains a concise history (from RN/ED team/family members) (must ask all three to get credit) | 2 (20%) | 9 (90%) | < 0.001 |
| States out loud the patient's level of alertness | 2 (20%) | 10 (100%) | < 0.001 |
| Examines eyes | 5 (50%) | 9 (90%) | 0.02 |
| Examine for any focal weakness | 6 (60%) | 10 (100%) | 0.02 |
| Evaluating and stabilizing the patient (after witnessed seizure noted) | |||
| States that the patient is having a seizure | 5 (50%) | 10 (100%) | 0.01 |
| States out loud time of seizure onset | 1 (10%) | 10 (100%) | < 0.001 |
| Calls for help | 8 (80%) | 10 (100%) | 0.53 |
| Reposition patient on to the side | 4 (40%) | 9 (90%) | 0.01 |
| Evaluates patient's airway: suction patient | 3 (30%) | 10 (100%) | < 0.001 |
| Places pulse oximeter | 9 (90%) | 10 (100%) | 0.62 |
| Asks RN to provide oxygen if the patient is hypoxic | 8 (80%) | 9 (90%) | 0.58 |
| Asks RN to check blood pressure | 9 (90%) | 10 (100%) | 0.62 |
| Asks RN to initiate telemonitoring (EKG) and ensures that this gets done by RN | 6 (60%) | 10 (100%) | 0.02 |
| Performs a brief neurological exam: must check or ask RN if any eye deviation | 2 (20%) | 10 (100%) | < 0.001 |
| Management | |||
| Ensures that the patient has a working IV access | 4 (40%) | 10 (100%) | 0.01 |
| Orders 1st-line ASD (must be given within 5 min of seizure onset) | 10 (100%) | 10 (100%) | > 0.999 |
| Asks RN to check finger stick blood glucose | 5 (50%) | 10 (100%) | 0.01 |
| Orders labs | 9 (90%) | 100 (100%) | > 0.999 |
| Order a second ASD (needs to be ordered within 5 min from ordering first ASD) | 2 (20%) | 9 (90%) | < 0.001 |
| Calls pharmacy or asks RN to call the pharmacy to communicate the emergent need for ASDs | 3 (30%) | 10 (100%) | < 0.001 |
| Orders a stat head CT | 5 (50%) | 10 (100%) | 0.01 |
| Communicates with attending physician/fellow on-call to staff the case | 3 (30%) | 10 (100%) | < 0.001 |
| States out loud the concern for nonconvulsive status | 3 (30%) | 10 (100%) | < 0.001 |
| Re-evaluating the case | |||
| Orders a postload ASD level | 0 | 8 (80%) | < 0.001 |
| Orders an emergent EEG and call the on-call fellow to ask for a stat EEG | 3 (30%) | 10 (100%) | < 0.001 |
| Makes appropriate decision regarding disposition/level of care (ICU) and communicates this decision to the nurse | 4 (40%) | 10 (100%) | 0.01 |
The drug selection in this checklist was based on published guidelines at the time and prior to recent publications showing levetiracetam as an option for the treatment of status epilepticus [20]
ASD Antiseizure drug, CBC Complete blood count, CMP Complete metabolic profile, CT Computed tomography, ED Emergency department, EEG Electroencephalogram, EKG Electrocardiogram, ICU Intensive care unit, IM Intramuscular, IV Intravenous, RN Register nurse