This is a web-based activity designed to help you evaluate your current EMU examination practices and develop and implement a standardized ictal and post-ictal exam for your EMU setting. The main focus for this performance improvement project is to develop or improve an ictal and post ictal testing/seizure exam for patients with focal epilepsy, which can enhance peri-ictal care in the EMU setting.

There are 5 “standardized exam components” for the ictal and post ictal periods. The standard exam components would allow centers to compare their practice implementations to other centers. In addition, centers can choose to add supplementary exam components, but these components will not be used for data comparison with other centers.

The activity is comprised of 3 stages:

Stage A –Perform a quality improvement evaluation that involves reviewing charts, EMU reports, and/or VEEG seizure recordings for 5 EMU patients over the age of 12. Evaluate and reflect, using the proposed quality metrics, on ictal and post ictal testing performed and identify areas for improvement.

Stage B - Based on the results of Stage A, develop, and implement a plan to optimize clinical information capture during and after seizures while maintaining patient safety. This should involve the creation of a standardized ictal and post ictal exam. Additional exam components can also involve visual aids such as a poster or a flip card etc. Two such ictal and post ictal exam examples are also included in the “Tools.”

Stage C - Evaluate the impact of your intervention by performing a second review of patient charts, EMU reports, and/or VEEG seizure recordings of 5 EMU patients over the age of 12 by utilizing the quality metrics in Stage A to assess whether ictal and post-ictal examination have improved.

Following completion of this activity, the learner should be able to:

1. Recognize features of seizure event and perform the exam components as appropriate.
2. Maximize information capture while maintaining patient safety.
3. List strategies for improving bedside exam and standardize specifically tailored exams and reporting.

Accreditation

The American Epilepsy Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. 

Credit Designation

The American Epilepsy Society designates this enduring material activity for a maximum of 20 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

International Credits:  The American Medical Association has determined that non-US. licensed physicians who participate in this CME activity are eligible for AMA PRA Category 1 Credits™.

Physician Assistants:  AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credits™ from organizations accredited by ACCME or a recognized state medical society.  Physician assistants may receive a maximum of 20 hours of Category 1 credit for completing this program.

Instructions for Participation to Earn CME Credit

• Read the needs statement, target audience, learning objectives, and planner/faculty disclosures.
• Complete stages A, B and C online or printed out.
• Complete the evaluation.

Maintenance of Certification

The American Board of Psychiatry and Neurology has reviewed the PI-CME activity " In-Patient Epilepsy Monitoring Unit (EMU) Performance Improvement Project (PIP)  – Ictal and Post-ictal Awareness and Localization Testing in Focal Seizures" and has approved this program as part of a comprehensive Improvement in Medical Practice (PIP) program, which is mandated by the ABMS as a necessary component of maintenance of certification.

NOTE: Purchasing this PI CME activity does not enroll the purchaser in the Maintenance of Certification (MOC) program. For more information about MOC, please contact that American Board of Psychiatry and Neurology directly.

In accordance with the ACCME Standards for Commercial Support, the AES requires that any person who is in a position to control content of a CME activity must disclose all relevant financial relationships that they have with a commercial interest. Unless otherwise indicated (*), none of the planners or faculty of this activity have any financial relationships to disclose. All relevant financial relationships with commercial interests have been mitigated. The following individuals contributed to this activity’s content.

Faculty/Authors

Rebecca Spiegel, MD, MA, Stony Brook Comprehensive Epilepsy Center, Stony Brook NY
Susan Koh, MD, Children’s Hospital of Colorado, Denver, CO
Lindsay M. Higdon, MD, Thomas Jefferson University Hospital, Philadelphia, PA
Chloe Hill, MD, University of Michigan, Ann Arbor, MI
Gabriel Martz, MD, Hartford Health Care, Hartford, CT
Kameel Karkar, MD, UT Health, San Antonio, TX
Janel Schneider, MD, Ascension Wisconsin - Comprehensive Epilepsy and Seizure Care, Racine, WI
Aashit Shah, MD, Carilon Clinic, Roanoke, VA
Alexandra Urban (Popescu), MD, University of Pittsburgh, Pittsburgh, PA
Anu Venkat, MD, Saint Peters University Hospital, New Brunswick, NJ

Planners

Rebecca Spiegel, MD, MA
Gabriel Martz, MD 
Lindsay M. Higdon, MD
Susan Koh, MD 
Anup Patel, MD 

AES Staff

CME Reviewer

Shahram Izadyar, MD, SUNY Upstate Medical Center, Baldwinsville, NY 

Resolution of Conflicts of Interest

It is the policy of the American Epilepsy Society to ensure balance, independence, objectivity and scientific rigor. All persons involved in the selection, development and presentation of content are required to disclose any real or apparent conflicts of interest. In accordance with the ACCME Standards for Commercial Support of CME, the AES implemented the mechanisms of prospective peer review of this CME activity, to identify and resolve any conflicts. Additionally, the content of this activity is based on the best available evidence.

Unapproved Use Disclosure

The American Epilepsy Society requires CME authors to disclose to learners when products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not FDA approved); and any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. This information is intended solely for continuing medical education and is not intended to promote off-label use of these medications. If you have questions, contact the medical affairs department of the manufacturer for the most recent prescribing information. Information about pharmaceutical agents/devices that is outside of U.S. Food and Drug Administration approved labeling may be contained in this activity.

Contact Information

For further information on this activity contact the American Epilepsy Society at education@aesnet.org or call 312.883.3800.

Commercial Support

No commercial support was received for this activity.

Privacy and Confidentiality

The American Epilepsy Society respects the privacy and confidentiality of users of this CME activity. You may access the privacy statement for this activity here.

Policy on Commercial Support and Conflict of Interest

As an ACCME-accredited provider the American Epilepsy Society must ensure 100% compliance with the ACCME Standards for Commercial Support: Standards to Ensure Independence in CME Activities. The American Epilepsy Society has implemented mechanisms, prior to the planning and implementation of this CME activity, to identify and resolve conflicts of interest for all individuals in a position to control content of this CME activity

Disclosure of Unlabeled/Unapproved Uses

This educational activity may include references to the use of products for indications not approved by the FDA. Faculty have agreed to disclose intent to discuss any off-label, experimental, or investigational use of drugs, devices, or equipment or devices in their presentations.  Furthermore, faculty have attested that all the recommendations involving clinical medicine they make in this activity will be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients; and, all scientific research referred to, reported, or used in their presentation in support or justification of a patient care recommendation will conform to the generally accepted standards of experimental design, data collection and analysis.  Faculty opinions expressed with regard to unapproved, investigational or experimental uses of products are solely those of the faculty and are not endorsed by the American Epilepsy Society.

Disclaimer

This CME activity is for educational purposes only and does not constitute the opinion or endorsement of, or promotion by, the American Epilepsy Society. Reasonable efforts have been taken to present educational subject matter in a balanced, unbiased fashion, and in compliance with regulatory requirements. However, each activity participant must always use his or her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label, investigational and/or experimental uses.