EEG - Electroencephalography Patient Safety and Ethics Questions and Answers 1 — Questions and Answers
Question 1: An 82-year-old patient with severe dementia is brought from a nursing home for a routine EEG. The patient is unable to state their name or understand the procedure. Who is the most appropriate individual to provide informed consent for the EEG?
- The patient, after the technologist explains in very simple terms.
- The registered nurse who accompanied the patient from the facility.
- The patient's legally authorized representative or next of kin. (Correct answer)
- The ordering neurologist who determined the procedure was necessary.
Correct answer: The patient's legally authorized representative or next of kin.
When a patient lacks the cognitive capacity to make an informed decision, consent must be obtained from their legally authorized representative (e.g., a person with durable power of attorney for healthcare or a legal guardian). This individual is empowered to make healthcare decisions on the patient's behalf. The ordering physician determines medical necessity but cannot provide consent for the patient, and an accompanying nurse typically does not have legal authority to consent unless they are also the legal representative.
Question 2: Which of the following actions by an EEG technologist is a direct violation of the Health Insurance Portability and Accountability Act (HIPAA)?
- Discussing a complex EEG record with the interpreting neurologist in a private reading room.
- Using a hospital-provided, encrypted tablet to review a patient's prior EEG report.
- Looking up the medical records of a celebrity who is a patient in another part of the hospital out of curiosity. (Correct answer)
- Calling the patient's nurse to confirm their current list of medications.
Correct answer: Looking up the medical records of a celebrity who is a patient in another part of the hospital out of curiosity.
Accessing a patient's protected health information (PHI) without a legitimate, job-related reason is a serious HIPAA violation. Curiosity is not a valid reason for accessing records. The other options describe appropriate actions: consulting with the care team, using secure devices, and gathering necessary clinical information are all permissible uses of PHI for patient care.
Question 3: During a portable EEG in the ICU, the patient experiences a generalized tonic-clonic seizure. After ensuring the patient is safe and calling for nursing assistance, what is the technologist's primary responsibility related to the recording?
- Immediately stop the recording to prevent movement artifact from obscuring the data.
- Protect the EEG machine from being damaged by the patient's movements.
- Continue recording and meticulously document all clinical manifestations and the exact time they occur. (Correct answer)
- Administer stand-by medication as ordered in the patient's chart.
Correct answer: Continue recording and meticulously document all clinical manifestations and the exact time they occur.
The technologist's primary role during a seizure is to ensure patient safety first, then to obtain a high-quality recording of the clinical and electrographic event. Accurately annotating the recording with observed clinical signs (e.g., 'tonic stiffening of all limbs,' 'head turn to left,' 'clonic jerking of right arm') is crucial for the interpreting physician. Stopping the recording would mean losing the most critical diagnostic data. Administering medication is outside the technologist's scope of practice.
Question 4: An alert and oriented adult patient provides consent for an EEG but adamantly refuses the hyperventilation (HV) activation procedure due to a history of panic attacks. Which of the following is the most appropriate course of action for the technologist?
- Insist that the patient attempt HV, as it is a required part of the standard procedure.
- Cancel the entire EEG study because it will be incomplete without the activation.
- Respect the patient's refusal, document it on the record, and proceed with the remainder of the EEG. (Correct answer)
- Ask a family member to convince the patient to perform the procedure.
Correct answer: Respect the patient's refusal, document it on the record, and proceed with the remainder of the EEG.
Competent adult patients have the right to refuse any part of a medical procedure. The technologist must respect the patient's autonomy. The proper action is to document the refusal clearly on the technologist's report and continue with the other parts of the study, such as photic stimulation and obtaining a sleep recording.
Question 5: To minimize the risk of electrical shock to the patient, what is the single most important electrical safety practice in the EEG laboratory?
- Using a notch filter to remove 60 Hz interference.
- Ensuring all electrodes have an impedance below 1 kOhm.
- Plugging all patient-connected equipment into the same properly grounded, hospital-grade outlet cluster. (Correct answer)
- Applying a separate ground electrode for each piece of monitoring equipment.
Correct answer: Plugging all patient-connected equipment into the same properly grounded, hospital-grade outlet cluster.
Using a single, common ground point for all equipment connected to the patient prevents the formation of ground loops and minimizes the risk of leakage currents passing through the patient. Plugging the EEG machine and any other connected devices into the same outlet block ensures they share a common ground reference. Applying multiple ground electrodes from different pieces of equipment can be dangerous and is known as 'double grounding'.
Question 6: What is the standard infection control practice for disinfecting non-disposable surface cup electrodes after use on a patient with an intact scalp and no known infectious diseases?
- Soaking the electrodes in hot, soapy water for 30 minutes.
- Wiping the electrodes with a 70% isopropyl alcohol pad.
- Placing the electrodes in an autoclave for steam sterilization.
- Mechanically cleaning the electrodes, then immersing them in an appropriate intermediate-level disinfectant. (Correct answer)
Correct answer: Mechanically cleaning the electrodes, then immersing them in an appropriate intermediate-level disinfectant.
Standard procedure requires a two-step process: first, mechanically cleaning the electrode with a brush or abrasive paste to remove all conductive media and organic material, followed by immersion in an EPA-registered, hospital-grade intermediate-level disinfectant for the manufacturer-recommended time. Wiping with alcohol is insufficient, and autoclaving would damage the electrodes. Soapy water alone does not provide disinfection.
EEG - Electroencephalography Patient Safety and Ethics Questions and Answers 1
An 82-year-old patient with severe dementia is brought from a nursing home for a routine EEG.
The patient is unable to state their name or understand the procedure.
Who is the most appropriate individual to provide informed consent for the EEG?