High-Fidelity Manikin Training Program Addresses Pitfalls in Epilepsy Monitoring Unit Care


Following development and implementation of a simulation laboratory training session to all staff in the EMU, there were statistically significant improvements in orientation assessment, speech assessment, motor assessment, oxygen administration, and vital sign collection in the short-term reassessment.

Jay Gavvala, MD, MSCI, an associate professor of neurology at the University of Texas McGovern Medical School

Jay Gavvala, MD, MSCI

A recently published pre-post intervention study showed that the implementation of a novel simulation-based education platform using a high-fidelity manikin led to wide-ranged improvements in epilepsy monitoring unit (EMU) staff performance of safety and testing measures. These results provide a framework to minimizing potential pitfalls seen in the EMU and to improve overall care and education.

Published in Neurology, the group of investigators first created an EMU safety checklist of critical seizure evaluation and safety measures to characterize the baseline practice of safety and testing assessments in the Baylor Comprehensive Epilepsy Center. Following that, the group implemented their novel simulation training program where staff members underwent 8 total training sessions lasting around an hour each.

The training session featured the Gaumard Susie High-Fidelity Simulation Manikin, or “patient,” pushing a button for a habitual aura. Staff members would come into the room and interact with the patient as it went through several different seizure progressions. Training was to be completed in teams of 3-4 staff members, with a “divide and conquer” approach, each performing different tasks and assuming different roles that they determined on their own. Immediately following the simulation exercise, a debriefing session occurred to identify strengths and weaknesses of the simulation laboratory exercise.

Led by Jay Gavvala, MD, MSCI, an associate professor of neurology at the University of Texas McGovern Medical School, 2 retrospective reassessments of Emu safety and evaluation practices from the initial checklist were performed after all staff had completed the stimulation training program in September 2021. The baseline review included 12 patients with 69 epileptic seizures who met inclusion criteria between July and September 2021. Using the same preassessment inclusion and exclusion criteria, the short-term reassessment occurred in April 2022 for EMU admissions from October to December 2021 (47 episodes; 17 patients). The long-term reassessments also occurred in April 2022 for EMU admissions from January to March 2022 (55 episodes, 17 patients).

At the conclusion of the analysis, between-group comparisons of baseline with the short-term and long-term interval reassessments showed statistically significant improvements in 3 of 8 evaluation checklist items (orientation assessment, P = .005; speech assessment, P = .001; and motor assessment, P = .0410 and in 2 of 5 safety measures (oxygen administration and vital sign collection, both P <.001). Memory assessment was the only task that was significant for declining performance (P = .002). Although there were no statistically significant differences between early and late postassessment groups, investigators did observe some variance.

After stratifying short- and long-term assessment periods, investigators concluded that regular training may be needed to sustain the improvements seen. Specifically, the subgroup findings showed that things like orientation assessment (P = .006), assessment of the patient’s ability to speak (P <.001), motor task assessment (P = .042), oxygen administration (P <.001), and vital sign collection (P <.001) were significantly improved in the early postintervention group whereas the late postintervention group had only significant improvements in 2 measures: oxygen administration (P = .006) and vital sign collection (P <.001). Additionally, this group saw a significant decline in memory assessment performance (P <.001).

READ MORE: Lifting Barriers to Equitable Care in Epilepsy

Gavvala et al wrote, "Currently, there are no available recognized guidelines for training personnel or best practices for maximizing patient safety in the EMU; we believe that the baseline knowledge and practice reflected this. Furthermore, we believe the current nursing model of an open EMU unit additionally diluted staff familiarity and comfort in best care practices in an EMU setting. Before the development of this educational vignette, staff education was focused on general neuroscience care and included 1 dedicated lecture on seizures."

They added, "In our opinion, this is much too brief to encompass the nuances of optimal EMU care. Due to emphasis of patient safety in nursing education, there was inherently more compliance in performing safety measures than testing. However, with more dedicated education, there was a significant corresponding improvement, highlighting the importance for seizure-specific safety and testing protocols for all staff in the EMU."

In the early postintervention group specifically, 8 checklist items were completed more than 50% of the time, which included cover removal (54.3%), side turn (55.6%), orientation assessment (56.8%), motor assessment (57.9%), speech assessment (73.5%), oxygen administration (77.3%), remaining at bedside until return to baseline (81.6%), and vital sign collection (86.8%). Investigators recorded slight nonsignificant faster time to responses from EEG onset following the program (33.0 vs 30.0 seconds; P >.05); however, the response time from clinical onset was also longer and statistically significant (22.0 vs 37.50 seconds; P = .003).

In the long-term reassessment period, the implementation of the program resulted in improvements in 12 of 14 checklist items, with memory assessment (14.5%) and camera obstruction (5.6%) as the only ones with relative decline. Accidents remained low (1.8%) and there were no statistically significant differences from baseline or the early reassessment group in the late group’s EEG or clinical response time (P >.181 all groups).

1. McLaren JR, Nascimento FA, Chakranarayan J, Olandoski M, Veerapaneni P, Gavvala JR. Education research: epilepsy monitoring unit staff education using a high-fidelity manikin: a pre-post intervention study. Neurology. 2024;3(1). doi:10.1212/NE9.0000000000200120.
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