A consensus-based approach to patient safety in epilepsy monitoring units: Recommendations for preferred practices

Patricia O. Shafer, Janice M. Buelow, Katherine Noe, Ruth Shinnar, Sandra Dewar, Paul M. Levisohn, Patricia Dean, David Ficker, Mary Jo Pugh, Gregory L. Barkley

Research output: Contribution to journalArticle

35 Scopus citations


Patients in an epilepsy monitoring unit (EMU) with video-EEG telemetry have a risk for seizure emergencies, injuries and adverse events, which emphasizes the need for strategies to prevent avoidable harm. An expert consensus process was used to establish recommendations for patient safety in EMUs. Workgroups analyzed literature and expert opinion regarding seizure observation, seizure provocation, acute seizures, and activity/environment. A Delphi methodology was used to establish consensus for items submitted by these workgroups. Fifty-three items reached consensus and were organized into 30 recommendations. High levels of agreement were noted for items pertaining to orientation, training, communication, seizure precautions, individualized plans, and patient/family education. It was agreed that seizure observation should include direct observation or use of closed-circuit camera. The use of continuous observation was strongest in patients with invasive electrodes, at high risk for injury, or undergoing AED withdrawal. This process provides a first step in establishing EMU safety practices.

Original languageEnglish (US)
Pages (from-to)449-456
Number of pages8
JournalEpilepsy and Behavior
Issue number3
StatePublished - Nov 1 2012



  • Delphi methodology
  • Epilepsy
  • Epilepsy monitoring units
  • Expert consensus
  • Patient safety
  • Seizure observation
  • Seizure precautions
  • Video-EEG telemetry

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Behavioral Neuroscience

Cite this

Shafer, P. O., Buelow, J. M., Noe, K., Shinnar, R., Dewar, S., Levisohn, P. M., Dean, P., Ficker, D., Pugh, M. J., & Barkley, G. L. (2012). A consensus-based approach to patient safety in epilepsy monitoring units: Recommendations for preferred practices. Epilepsy and Behavior, 25(3), 449-456. https://doi.org/10.1016/j.yebeh.2012.07.014