Norma D. McNair, PhD, RN, CCRN, ACNS-BC
Clinical Nurse Specialist
Department of Nursing | 6 West
Ronald Reagan UCLA Medical Center
757 Westwood Plaza Suite B 790 A
Los Angeles, CA 90095-7404
310-267-7233 O | 90007 P
All seizure patients have pads; we also have suction and O2 available for the actual seizure. We have never had a problem with entrapment in a patient who had seizure pads on their bed. I think that the hospital runs a real risk of problems if they do not have seizure pads on beds for patients on the EMU, have a history of seizures or are admitted with seizures. Patients can (in my opinion) get badly hurt during a seizure if they are banging on the side rails or they get caught in the side rails. Given that most of us have indicated that we use seizure pads, one could argue that it is standard care and the hospital would have a hard time arguing against that point.
We still use seizure pads on all of our EMU patients. Nursing should also pad side rails of any other patient that is on sz precautions. At Duke we follow these guidelines: Seizure precautions are appropriate for: 1.) any patient that has a history of seizures and is being withdrawn from anticonvulsant medications; 2.) any patient with a history of falling, wandering, or other injury during a prior seizure; and 3.) any patient with a history of generalized tonic-clonic seizure activity in the last 2 years. Seizure precautions are not necessary for: 1.) patients seizure-free for more than 6 months who are not being withdrawn from their anticonvulsant medications; and 2.) patients who have had no loss of awareness during their seizures.
We are using seizure pads. They are used on all 4 rails in the EMU, as well as, having all 4 rails up when the patient is in bed. Seizure pads are also used on the other hospital units for any patient on seizure precautions. We also maintain non-rebreather masks & Yankeur suction –both with extra-long tubing in rooms of patients on seizure precautions. I agree with Norma. On the flip side, you could ask the hospital to provide the literature showing entrapment. I think there are articles on EMU safety that discuss use of seizure pads & you could look in the EMU Caring – Safety in the EMU modules. The article Safety in the EMU: Reaching Consensus by Jong Woo Lee & Aashit Shah—mentions use of side rail pads & I suspect you will find a few others if you do a search on PubMed or even Google.
I can’t think of a single time we had an issue of entrapment with seizure pads but can think of injuries (minor abrasions mostly) that have occurred as a result of not using seizure pads. I do think it is important to use the seizure pads that are specifically designed to fit the bed you are using though rather than using the one size fits all ones.
Also, funny to note that the description of the side rail pads says, “…bed rail pads PREVENT side-rail entrapment…” & “…PREVENT injuries due to entrapment…”
Linda R Parker BSN, RN-BC
Epilepsy Monitoring unit
Lakeside 4th floor
University Hospital Case Medical Center
Yes we use seizure pads for our seizure Patients too. All our beds are equiped with seizure pads and matts on the floor.
We do still use seizure pads for anyone in the EMU. Actually, any patient on seizure precautions for whatever the reason has seizure pads on their bed. For any patient with a known seizure history, especially those who have had an event "recently", we still abide by seizure pads on their bed with seizure precautions. Any patient who is being transitioned to another medication, withdrawn from a medication, or even those who underwent recent surgery for a seizure related illness, are still on seizure precautions as well.
Eileen Sherburne, MSN, ACNS-BC, FNP-BC, CRRN, CNRN, WCC Clinical Nurse Specialist - Spina Bifida Program Children's Hospital of WI
Regarding the use of seizure pads I have two colleagues who are staff RNs who recently completed a study looking at the effectiveness of seizure pads in a pediatric EMU (I helped as a mentor). As background, bed technology has evolved to where siderails are solid plastic and no longer open bars and bumper pads are no longer used in cribs due to the risk of suffocation. As has been mentioned, current evidence is at the consensus level of expert opinion for the general recommendation for the use of seizure pads. Clore (2010) proposed an algorithm for seizure precations with the use of seizure pads based on seizure type and recommended pad use if the patient has motor involvement during the seizure.
The convenience sample was children admitted to the EMU over a 1 year period of time and who had a history of motor involvement with their seizure. There were 209 reviewable videos of which 69 videos (31 patients) had motor involved seizures on the video. The results showed the average age was 10.3 years (2.42-17.83 years) and average weight was 33kg (13.9-47.6 kg). There was one episode of forceful upper extremity contact with the side rail, and no episodes of entrapment during any seizure. Forty-three percent of seizures were over before the nurse entered the room. Nurses entered the room on average in 13 seconds (range 1-32 seconds). A regression analysis of 31 independent videos did not predict any variables that influenced patient contact with the bed rail.
We believe that this study supported an existing algorithm of the need for seizure pads in pediatric patients with specific types of seizures. A nursing assessment of seizure type with motor involvement, e.g. atonic seizure, generalized seizures, indicates a need for seizure pads but not all patients require seizure pads. Hospital beds with solid side rails are recommended and the seizure pads need to fit the rails properly. The size of the patient did not influence need for seizure pads.
Clore, E. T. (2010). Seizure precautions for pediatric bedside nurses. Pediatric nursing, 36(4), 191.