SeizureSafe™ Case Examples
This section presents real-world scenarios drawn from long-term care practice. Each example highlights key lessons to sharpen observation skills, improve team communication, and strengthen seizure management across all shifts and roles.
Index
Missed Absence Seizure During Morning Care
A brief blank stare was overlooked as inattention, leading to a preventable fall.
Behavior Misinterpreted as Outburst
Subtle seizure signs were mistaken for agitation, delaying medical follow-up.
Silent Seizure Revealed by Unwitnessed Fall
An unexplained fall raised suspicion of previously unrecognized silent seizure activity.
Quick Nursing Response During Meal Time
A nurse correctly identified seizure signs, preventing choking and injury.
Family Member Identifies Missed Event
A visiting family member reported behaviors that staff failed to document or escalate.
Night Shift Event and Documentation Gaps
An overnight seizure was witnessed but poorly reported, causing a communication breakdown.
Medication Change Triggers New Seizures
A recent medication change lowered the seizure threshold and introduced new risks.
Seizure Confused with Fainting Episode
A seizure was mistaken for syncope, delaying proper intervention.
Seizure During Transfer Causes Fall
A resident had a seizure mid-transfer, resulting in a preventable injury.
Post-Seizure Monitoring Missed
Staff failed to monitor recovery, leaving the resident vulnerable to additional harm.
Delayed Clinical Notification After Seizure Event
A witnessed event was not promptly reported to nursing, delaying assessment.
Conflicting Staff Reports of the Same Event
Multiple staff members gave inconsistent accounts, complicating clinical review.
Case Example: Missed Absence Seizure During Morning Care
Key Lesson
A brief blank stare was overlooked as inattention, leading to a preventable fall and missed clinical follow-up.
Scenario
At 7:15 AM, an aide assisted Mrs. L., an 84-year-old resident with moderate Alzheimer’s, during her morning dressing routine. Halfway through buttoning her blouse, Mrs. L. abruptly stopped moving, stared straight ahead, and did not respond to verbal cues or light physical prompts (hand touch, name repeated). The episode lasted approximately 30 seconds. Assuming it was just a “moment of confusion,” the aide gently redirected Mrs. L. and completed dressing without documenting the event or informing the charge nurse.
Later that morning, Mrs. L. was found on the floor near her room doorway after an unwitnessed fall.
What Went Wrong
The aide misinterpreted the brief, unresponsive episode as a regular part of dementia rather than a potential seizure. No immediate report or documentation was made, and no one was alerted to watch for related symptoms. As a result, clinical staff missed an opportunity to assess Mrs. L.’s neurological status and implement fall precautions. The subsequent fall, while not causing serious injury, led to a family complaint and triggered a facility investigation.
Lessons Learned
- Always take sudden, unexplained pauses or unresponsiveness seriously, even if the resident seems to recover quickly.
- Document exactly what you observed, including duration, behavior, and responsiveness, without making assumptions.
- Promptly escalate any out-of-character events to your nursing supervisor for review, especially when they involve a resident with cognitive impairment.
- Remember: what looks small can have bigger clinical implications when patterns are missed.
Related Hub Content
See Seizure Recognition Lesson 1.2 (Common Signs to Watch For) and Seizure Documentation Lesson 3.2 (How to Document What You Saw).
Think About This
Have you ever seen a resident suddenly “check out” or freeze in place? Did you document it or mention it in the shift report? How would you respond differently after reading this case?
Case Example: Behavior Misidentified as Outburst
Key Lesson
Repetitive, purposeless movements and brief unresponsiveness were mislabeled as behavioral issues, delaying neurological assessment and leading to injury.
Scenario
During the late afternoon shift, Mr. J., a 79-year-old resident with vascular dementia, became suddenly agitated in the common area. Staff observed him wringing his hands repeatedly, tugging at his shirt collar, and muttering the same word repeatedly. When approached, he did not respond to verbal cues and appeared fixated on his repetitive movements for about 45 seconds. The behavior stopped on its own, and Mr. J. seemed momentarily confused but quickly returned to baseline. Staff noted the incident as a “behavioral outburst” in the chart, citing agitation and non-compliance, with no further follow-up.
Two days later, Mr. J. experienced a fall with injury after another unexplained episode that was again labeled as behavioral. Only after this second event did the nursing staff recognize a pattern and begin neurological follow-up.
What Went Wrong
The initial episode showed clear signs of possible seizure activity—automatisms such as hand wringing, repetitive speech, and temporary unresponsiveness. By labeling this as a behavioral issue without deeper assessment, the staff missed the opportunity to escalate concerns and monitor Mr. J.’s condition. This delayed clinical review placed the resident at risk of preventable harm.
Lessons Learned
- Repetitive, purposeless movements combined with unresponsiveness should raise suspicion of seizure activity, not just behavioral agitation.
- Documentation must factually describe what is observed, avoiding assumptions or labels without clinical input.
- When a resident suddenly becomes agitated or repetitive in an unusual way, escalate to the clinical team for review.
- Early recognition of subtle seizure patterns can prevent injury and improve clinical care.
Related Hub Content
See Seizure Recognition Lesson 1.2 (Common Signs to Watch For) and Seizure Documentation Lesson 3.2 (How to Document What You Saw).
Think About This
Have you ever documented a resident’s repetitive or unusual behavior as simply “agitation” or “non-compliance”? What might you do differently after seeing this case?
Case Example: Silent Seizure Revealed by Unwitnessed Fall
Key Lesson
Unexplained falls can signal undiagnosed seizure activity, and missing early signs increases injury risk and delays clinical intervention.
Scenario
Mrs. P., an 86-year-old resident with advanced Alzheimer’s, was found on the floor near her bathroom shortly after morning rounds. No staff had witnessed the fall, and there were no apparent trip hazards or environmental causes. Mrs. P. reported feeling “dizzy” before the fall but could not provide further details. Staff assisted her back to bed, assessed her for injury, and documented the incident as an unwitnessed fall due to presumed weakness. No neurological assessment was completed at that time.
In the following weeks, Mrs. P. had two additional unexplained falls, prompting a deeper review by the clinical team. Upon closer investigation, it became apparent that she had displayed brief periods of unresponsiveness in the days leading up to the incidents, which had not been reported or documented.
What Went Wrong
The initial fall was treated as an isolated mechanical event without considering other possible medical causes. No questions about preceding symptoms, such as confusion, blank stares, or altered awareness, were asked. The care team missed early clues of seizure activity by failing to investigate subtle signs and patterns. The delay in recognizing the pattern increased the resident’s risk of injury and led to avoidable repeat incidents.
Lessons Learned
- Unexplained falls, especially in residents with dementia, may be linked to undiagnosed seizure activity and require a thorough review.
- Always ask what the resident was doing or feeling just before a fall, even if the answer is limited.
- Document any signs of altered awareness, dizziness, or blank stares that may have preceded the fall.
- Escalate unexplained falls to the clinical team for deeper evaluation, not just environmental review.
Related Hub Content
See Seizure Recognition Lesson 1.2 (Common Signs to Watch For) and Seizure Documentation Lesson 3.2 (How to Document What You Saw).
Think About This
Have you encountered a resident fall that seemed unexplained or out of character? Did you consider whether subtle seizure activity could have been a factor?
Case Example: Successful Nursing Response During Meal Time
Key Lesson
Quick recognition and immediate intervention during a subtle seizure prevented choking and ensured timely clinical follow-up.
Scenario
During lunch service, Mr. S., a 77-year-old resident with mixed dementia, was eating independently in the dining room when a nurse noticed him suddenly freeze mid-bite. He became completely still, staring ahead without responding to verbal prompts. His lips twitched slightly, and his right hand trembled while holding his fork. The episode lasted approximately 40 seconds. The nurse immediately approached, ensured the resident’s airway was clear, and quietly removed his plate to prevent choking. After the episode resolved, Mr. S. appeared confused and fatigued but remained seated safely.
The nurse documented the incident in detail, promptly notified the charge nurse and on-call provider, and alerted the dietary team to watch for any further episodes. Within 24 hours, the provider adjusted Mr. S.’s care plan, adding seizure precautions and ordering a follow-up neurological assessment.
What Went Right
The nurse quickly recognized the signs of subtle seizure activity and responded appropriately to ensure the resident’s safety. The episode was documented in clear, objective language, allowing for immediate clinical follow-up. The team communicated effectively across shifts and departments, resulting in timely care plan adjustments that reduced future risk.
Lessons Learned
- Seizure activity during meals presents a high choking risk and requires immediate, calm intervention.
- Staff should always watch for sudden freezing, staring, or subtle motor changes in residents with cognitive impairment, especially during high-risk activities like eating.
- Clear documentation and prompt notification allow clinical teams to respond effectively and protect resident safety.
- Early identification and reporting can prevent complications and improve resident outcomes.
Related Hub Content
See Seizure Response Lesson 2.1 (Responding When a Seizure Happens) and Seizure Documentation Lesson 3.2 (How to Document What You Saw).
Think About This
Have you witnessed a resident suddenly freeze or become unresponsive during a meal? Would you feel confident stepping in quickly and documenting the event with the right detail?
Case Example: Family Reports Unrecognized Event at Visit
Key Lesson
Family observations can reveal subtle seizure activity that staff might miss. Dismissing these reports delays care and risks damaging trust.
Scenario
Ms. R., a 74-year-old resident with Lewy body dementia, was visited by her daughter during an afternoon visit. While sitting together, the daughter noticed Ms. R. suddenly stop speaking mid-sentence, stare blankly, and perform a repetitive lip-smacking motion for about 20 seconds. Concerned, the daughter reported the incident to a nearby staff member, who reassured her that such behaviors were typical in dementia and did not escalate the concern further.
Later that evening, the daughter called the facility administrator to express her unease and to request a medical review. This prompted the nursing team to investigate more closely, leading to the recognition that Ms. R. may have experienced a subtle seizure that had previously gone unnoticed.
What Went Wrong
The initial staff response downplayed a potentially significant neurological event, missing an opportunity for timely clinical follow-up. The team delayed a proper medical assessment by dismissing the family’s observation without documenting or escalating it. This undermined trust with the family and exposed the facility to potential reputational and regulatory risk.
Lessons Learned
- Families are valuable partners in observation, especially during visits when subtle changes may be noticed.
- Any family member’s report of unusual behavior should be documented and escalated for clinical review, even if staff believe it may be benign.
- Never dismiss or minimize a family’s concerns without proper assessment and follow-up.
- Communication and responsiveness strengthen family trust and protect the facility from complaints or citations.
Related Hub Content
See Seizure Recognition Lesson 1.2 (Common Signs to Watch For) and Seizure Documentation Lesson 3.2 (How to Document What You Saw).
Think About This
Have you ever received a report from a family member about unusual resident behavior? Did you take it seriously and ensure it was followed up appropriately?
Case Example: Night Shift Escalation and Documentation Breakdown
Key Lesson
Verbal escalation alone is not enough—documentation and shift handoffs are critical to ensuring patterns are recognized and follow-up care is timely.
Scenario
At 2:30 AM, a night shift aide observed Mr. B., a 76-year-old resident with advanced dementia, sitting up in bed, staring blankly and making repetitive rubbing motions on his blanket. The episode lasted about one minute, after which Mr. B. lay back down and appeared confused but unharmed. The aide immediately notified the charge nurse, who assessed the resident and noted no acute distress or injury. However, the charge nurse became busy with other duties and did not document the event in the medical record or report it during the morning shift handoff.
Later that week, Mr. B. experienced another event during the day, and the new episode was treated as an isolated incident because no one was aware of the prior event. This delayed further clinical review and led to missed opportunities for earlier intervention.
What Went Wrong
Although the aide responded appropriately by escalating the concern to the charge nurse, the lack of documentation and failure to communicate the event to the next shift created a critical gap in care continuity. The clinical team could not recognize a developing pattern without a record of the night event, and risk mitigation steps were delayed.
Lessons Learned
- Immediate verbal escalation of an event is essential, but must always be followed by clear, timely documentation in the medical record.
- Shift handoffs must include significant overnight incidents, even if the resident appears stable afterward.
- A single missed entry in documentation can result in fragmented care and missed patterns that put residents at risk.
- Night shift teams must be as diligent with documentation and communication as day shifts, despite lower staffing and fewer interruptions.
Related Hub Content
See Seizure Documentation Lesson 3.2 (How to Document What You Saw) and Seizure Response Lesson 2.3 (Post-Seizure Monitoring).
Think About This
Have you ever escalated a concern verbally but forgotten to document it? How might that impact the care team’s ability to follow up properly?
Case Example: Medication Change Triggers New Seizures
Key Lesson
New medications can lower the seizure threshold. Subtle behavior changes after a prescription change should always be reported and reviewed.
Scenario
Mrs. K., an 82-year-old resident with Alzheimer’s disease, was recently prescribed a new antidepressant by her primary care provider. Within days, staff began noticing subtle changes in her behavior. During morning care, Mrs. K. had two brief episodes where she froze mid-task, stared straight ahead, and appeared momentarily dazed. These incidents lasted less than 30 seconds each and were resolved without intervention. Staff noted them in daily progress notes but did not connect the timing to the recent medication change or notify the clinical team.
A week later, Mrs. K. experienced a more significant seizure event that required emergency medical attention. Only during post-incident review did staff and clinicians recognize that the earlier episodes were likely early warning signs.
What Went Wrong
Staff documented the unusual behaviors but failed to recognize a potential link between the new medication and emerging seizure activity. No one escalated the observations for clinical review. This missed opportunity delayed appropriate intervention and contributed to the escalation of seizure risk.
Lessons Learned
- New medications, especially those that affect the central nervous system, can lower the seizure threshold and require close monitoring for subtle changes.
- Staff should be trained to report any new or unusual resident behaviors after medication changes, even if they seem minor.
- Early documentation is essential, but so is ensuring that unusual observations are brought to the attention of nursing or medical staff for timely review.
- Medication reviews should always include seizure risk considerations for residents with cognitive impairment.
Related Hub Content
See Seizure Recognition Lesson 1.3 (Who’s at Risk for Seizure Activity) and Seizure Documentation Lesson 3.2 (How to Document What You Saw).
Think About This
Have you ever noticed behavioral changes in a resident shortly after a new medication was started? Did you escalate those concerns for clinical review or assume they were unrelated?
Case Example: Seizure Confused with Fainting Episode
Key Lesson
Seizures and syncope can look similar. Clear observation and escalation are essential to avoid mislabeling events and delaying care.
Scenario
Mr. L., a 75-year-old resident with Parkinson’s disease and mild cognitive impairment, collapsed suddenly while walking to the dining room. Staff witnessed the event and reported that he became pale, fell to the floor without warning, and was briefly unresponsive for about 20 seconds. He regained consciousness quickly and was oriented but complained of dizziness. Staff assumed the incident was a syncopal (fainting) episode related to low blood pressure and documented it as such. No neurological assessment or seizure precautions were initiated.
Two weeks later, Mr. L. experienced another event, this time with apparent seizure-like activity, including limb jerking and prolonged confusion. A review of the earlier incident revealed that it may have been a seizure misidentified as syncope.
What Went Wrong
The team relied on assumptions and labeled the initial event as syncope without a complete clinical assessment. Important details—such as unresponsiveness and rapid recovery—were documented, but no escalation for neurological evaluation took place. This delayed the proper diagnosis and management of an emerging seizure disorder.
Lessons Learned
- Seizures and syncope can present similarly, especially in elderly residents. Distinguishing between them requires careful observation and clinical evaluation.
- Staff should avoid making medical assumptions and instead report objective facts.
- Any sudden collapse accompanied by unresponsiveness, even if brief, should prompt a complete assessment by nursing and potentially a medical provider.
- Early escalation and documentation strengthen care quality and reduce the risk of misdiagnosis.
Related Hub Content
See Seizure Recognition Lesson 1.2 (Common Signs to Watch For) and Seizure Documentation Lesson 3.2 (How to Document What You Saw).
Think About This
Have you ever assumed a resident’s sudden collapse was fainting? How can you improve your observation and reporting to help clinical teams make accurate assessments?
Case Example: Seizure During Transfer Causes Fall
Key Lesson
Seizures can occur during routine tasks like transfers. Recognizing the signs and prioritizing safety over task completion prevents injuries and delays in care.
Scenario
During a morning shift, Ms. T., an 80-year-old resident with late-stage Alzheimer’s, was transferred from her bed to a wheelchair by two aides using a gait belt. Mid-transfer, she suddenly became rigid and unresponsive, followed by brief jerking movements of her arms and legs. The aides, startled and unsure how to respond, attempted to complete the transfer quickly. In the process, Ms. T. slipped partially from the wheelchair and sustained a minor arm injury. Afterward, she appeared drowsy and confused. The aides reported the incident as a “fall during transfer” but did not note the seizure-like episode.
A nurse reviewing the report later raised concerns about the stiffness and jerking described, leading to a delayed but necessary neurological evaluation.
What Went Wrong
The aides were unprepared to recognize or respond appropriately to a mid-transfer seizure. Their focus on completing the task, rather than stabilizing and protecting the resident, led to avoidable injury. The lack of detailed reporting about the resident’s sudden rigidity and jerking also delayed clinical understanding of what had happened.
Lessons Learned
- Seizures can occur unexpectedly during transfers, making it critical to pause and prioritize safety over completing the task.
- Staff must be trained to recognize seizure activity and understand how to protect residents from harm during an event.
- Accurate reporting of all observed behaviors, including sudden changes in muscle tone or involuntary movements, ensures clinical teams can assess the situation appropriately.
- Team members should never hesitate to stop a transfer if a resident’s condition suddenly changes.
Related Hub Content
See Seizure Response Lesson 2.1 (Responding When a Seizure Happens) and Seizure Documentation Lesson 3.2 (How to Document What You Saw).
Think About This
Have you ever encountered a resident who became stiff or unresponsive during a transfer? How confident are you in your ability to respond safely and clearly document what happened?
Case Example: Post-Seizure Monitoring Missed
Key Lesson
A seizure doesn’t end when visible symptoms stop. Postictal monitoring is critical to ensuring safety and detecting complications.
Scenario
Mr. D., a 78-year-old resident with moderate dementia, experienced a brief seizure while seated in a lounge chair. The event lasted about 45 seconds, and staff responded quickly, ensuring he was safe and did not sustain injury. However, after the seizure ended, Mr. D. appeared very drowsy and disoriented. Staff, believing the event was over, left him unattended to resume other duties. Approximately 20 minutes later, another resident found Mr. D. slumped sideways in the chair, pale and visibly shaken, prompting a renewed staff response
A post-incident review revealed that no formal post-seizure monitoring had been implemented, and no vital signs were taken after the event.
What Went Wrong
Although the initial response was timely, staff mistakenly assumed their role ended when the visible seizure stopped. Without monitoring Mr. D.’s recovery period (the postictal phase), vital warning signs were missed, and the resident was left vulnerable to complications. The lack of clear post-event documentation and follow-up weakened the facility’s ability to demonstrate proper care during review.
Lessons Learned
- The postictal period requires close monitoring, as residents may experience confusion, weakness, or further complications after a seizure.
- Staff should remain with the resident for at least 10 to 15 minutes following a seizure to observe recovery and ensure safety.
- Vital signs and observations should be documented thoroughly to support clinical follow-up.
- Never assume a seizure event is “over” simply because visible symptoms have stopped.
Related Hub Content
See Seizure Response Lesson 2.3 (Post-Seizure Monitoring) and Seizure Documentation Lesson 3.2 (How to Document What You Saw).
Think About This
Have you ever responded to a seizure and left the resident alone too soon? How can you improve your follow-up care to ensure complete safety during recovery?
Case Example: Delayed Clinical Notification After Event
Key Lesson
Delaying clinical notification after a seizure can result in lost details, weakened documentation, and missed opportunities for timely evaluation.
Scenario
Ms. E., an 81-year-old resident with mixed dementia, experienced a seizure while in her recliner during a late morning activity session. Staff witnessed the episode, which lasted about one minute, and responded appropriately by ensuring her safety and observing her until she returned to baseline. However, the staff did not notify the charge nurse immediately due to shift change pressures and other urgent tasks. The event was mentioned briefly several hours later during afternoon rounds.
When the clinical team assessed Ms. E., she had no lingering symptoms, and critical details about the event’s onset, duration, and characteristics were unclear because the initial witnesses were no longer on duty.
What Went Wrong
The staff’s delay in notifying clinical leadership compromised timely medical evaluation. Important details were lost, and the opportunity to document the event comprehensively in real time was missed. This weakened the facility’s ability to provide a clear clinical picture and increased liability risk in the event of a follow-up incident.
Lessons Learned
- Immediate notification of seizure events to nursing leadership is essential for timely assessment and appropriate care planning.
- Relying on shift change or delayed reporting increases the risk of lost details and miscommunication.
- Even if a resident appears stable after an event, early clinical review is crucial to rule out complications and accurately document the incident.
- Clear communication protocols between frontline staff and clinical teams strengthen resident safety and compliance.
Related Hub Content
See Seizure Response Lesson 2.2 (Communication After a Seizure) and Seizure Documentation Lesson 3.2 (How to Document What You Saw).
Think About This
Have you ever delayed reporting an event because other tasks seemed more urgent? How can you ensure that immediate notification becomes a standard part of your seizure response routine?
Case Example: Conflicting Staff Reports of the Same Event
Key Lesson
When multiple staff members witness an event, coordinated communication is essential to avoid conflicting documentation that delays clinical decisions.
Scenario
During a group activity in the standard room, Mr. G., a 79-year-old resident with frontotemporal dementia, was observed by several staff members to have an unusual episode. One aide reported staring blankly and becoming unresponsive for about 20 seconds. Another aide noted that he briefly shook his hands. A third staff member said she saw no abnormal behavior at all. The team did not discuss the event together, and each member documented their version separately, resulting in conflicting reports in the medical record.
When the clinical team reviewed the notes, it was unclear what had happened. This delayed decision-making about whether the event required further neurological assessment or adjustments to the care plan.
What Went Wrong
Although multiple staff members witnessed the event, poor communication and a lack of team coordination resulted in inconsistent documentation. This created confusion for the clinical team, weakened the reliability of the record, and hindered effective follow-up care.
Lessons Learned
- When multiple staff members witness an event, it is essential to communicate as a team before documenting to ensure a unified and factual report.
- Objective observation is key—describe what was seen without interpretation and clarify discrepancies through discussion before finalizing notes.
- Consistency in documentation strengthens the clinical picture and protects staff and the facility from misunderstandings or regulatory concerns.
- Team-based reporting improves the accuracy of records and supports timely clinical decisions.
Related Hub Content
See Seizure Documentation Lesson 3.2 (How to Document What You Saw) and Seizure Response Lesson 2.2 (Communication After a Seizure).
Think About This
Have you ever documented an event without first discussing it with other staff who witnessed it? How can your team improve communication to ensure clear and accurate reports?
Disclaimer
Case examples are provided for educational purposes only and should not be used to replace clinical judgment or facility protocols.
Next Steps
- Review the Seizure Observation Checklist and other tools in the Downloads module.
- Revisit Module 1 (Recognition) and Module 2 (Response) for additional practice with spotting and handling seizure activity.
- Use the case examples as discussion starters during staff huddles or training sessions.
- Proceed to the Downloads module for printable quick-reference tools and guides.
- Return to Hub Landing Page