Recommendations Based on Literature Reviewed
Haley Johnson, Ann Kunstleben,
Andrea Nyquist, & Megan Zimmer
Approximately 10% of Americans will experience a
single, unprovoked seizure. In the United States, the
prevalence of epilepsy increases with age and is estimated
to affect 2.7 million Americans.
American Association of Neuroscience Nurses, 2009
These recommendations are
intended to identify patients
who are at risk for a seizure and
outline safety precautions to
maintain a patent airway and
prevent injury in the event of a
Review of Evidence-Based Literature
A literature review was conducted using the following search terms: seizure, nursing
seizure precautions, risk, environmental safety, padded side rail, and epilepsy. Search databases
included Medline, ScienceDirect, CINAHL Plus, and PubMed. Combining the terms
seizure, risk, injury, nursing, epilepsy, precaution, and prevention revealed no research
articles, one professional association guideline (Level D), and eight expert opinion journal
articles (Level E). These are assigned levels of evidence when compared to the American
Association of Critical Nurse (AACN) levels of evidence.
Another search of the aforementioned databases was performed using the search terms
pad, side rail, injury, seizure, precaution, prevention, and epilepsy. Lack of primary research
results for use of padded side rails to prevent patient injury demonstrated a lack of strong
research in this area.
The evidence leveling system used was AACN New Levels of
Evidence (Armola et al., 2009):
• Level A- Meta-analysis of multiple controlled studies or meta-
synthesis of qualitative studies with results that consistently
support a specific action, intervention or treatment
• Level B- Well designed controlled studies, both randomized and
nonrandomized, with results that consistently support a specific
action, intervention, or treatment
• Level C- Qualitative studies, descriptive or correlational
studies, integrative reviews, systematic reviews, or randomized
controlled trials with inconsistent results
• Level D- Peer-reviewed professional organizational
standards, with clinical studies to support recommendations
• Level E- Theory-based evidence from expert opinion or
multiple case reports
• Level M- Manufacturers’ recommendations only
Nurse will assess for risk of seizure:
• History of seizures (note frequency, classification, and sequence of events leading to
• On a seizure medication (level of adherence to medication regimen)
• History of brain injury
• Other conditions such as head trauma, stroke, preeclampsia, central nervous system
condition, and drug/alcohol withdrawal.
If risk is present, notify physician to consider an order for seizure precautions
(Buelow, 2013; Clore 2010; Ignatavicius & Workman, 2013; Smith & Caple, 2011; Caple & Schub, 2011)
If risk of seizure is present, the nurse will assess the environment for potential
sources for injury:
• Look for sharp objects including pens and pencils
• Keep bed in low position
• Loosen tight clothing, especially around the neck
• Consider removing excess furniture from the immediate patient care area
(Buelow, 2013; Fisher & Long, 2009; Hussey, 2012; Ignatavicius & Workman, 2013; Smith & Caple, 2011; Caple & Schub, 2011)
To assure for maintenance of a patent airway:
• Again, loosen restrictive clothing around the patient’s neck and chest
• Suction equipment available, in the room, and fully functional
• Oxygen source and delivery device in the patient's room
• Oral airway at bedside, hanging at the head of bed for easy access
(Buelow, 2013; Clore 2010; Hussey, 2012; Ignatavicius & Workman, 2013; Smith & Caple, 2011; Caple & Schub, 2011)
To protect the patient from injury:
• Identification of patient risk (magnet or sign outside of room, wrist band, communication to
patient care staff [including comment in transport flow sheet or ticket to ride])
• Educate the patient/family on reasons for seizure precautions, need to maintain precautions for
duration of admission, and to notify staff if an aura or seizure is experienced.
• Side rails padded and raised*
• Floor padding
• Antiepileptic drug (AED) treatment if necessary.
*Recent literature review is inconclusive if side rail padding prevents injury during seizure activity
(Buelow, 2013; Clore 2010;Hussey, 2012; Smith & Caple, 2011; Caple & Schub, 2011)
To accommodate to the St. Cloud
Hospital’s existing signage
methods, it is recommended that a
magnet be created to identify those
placed on seizure precautions.
• Thorough documentation in Epic, including patient assessment and risk, date
and time seizure precautions were implemented, any complications or
unexpected events, interventions performed, and all patient and family
• Education for the patient and family with a focus on prevention of
seizures, medication regimen, and patient safety. Consider providing a patient
education handout about seizure precautions.
• Additional educational key points may vary based on seizure etiology.
(Buelow, 2013; Clore 2010; Fisher & Long, 2009; Hussey, 2012; Ignatavicius & Workman, 2013; Smith & Caple, 2011; Caple & Schub, 2011)
Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M., Bucher, L., Harrington, L., … Medina, J. (2009). AACN levels of evidence: What’s new?
Critical Care Nurse, 29, 70-73.
Buelow, J. M. (2013). Kathleen Mears memorial lecture: An update on patient safety issues in the epilepsy monitoring unit. Neurodiagnostic Journal, 53(2),
Caple, C., & Schub, E. (2011). Skill competency checklist: Seizure precautions in adults: Initiating and maintaining. Glendale, CA: Cinahl Information Systems.
Caple, C., & Smith, N. (2011). Nursing practice and skill: Seizure precautions in adults: Initiating and maintaining. Glendale, CA: Cinahl Information Systems.
Clore, E. T. (2010). Seizure precautions for pediatric bedside nurses. Pediatric Nursing, 36(4), 191-194.
Epilepsy Foundation. (2010). First aid for seizures (convulsive, generalized tonic-clonic, grand mal). Retrieved from
Fisher, R., & Long, L. (2009). Care of the patient with seizures. Retrieved from http://www.aann.org/pdf/cpgaannseizures.pdf
Hussey, L. (2012). Nursing care before, during, and after a seizure. Retrieved from http://www.mosbysnursingconsult.com/nursing/clinical-updates/full-
text?clinical_update _id= 190223
Ignatavicius, D.D., & Workman, M.L. (2013). Medical surgical nursing: Patient-centered collaborative care (7th ed.). St. Louis, MO: Elsevier Saunders.