Epilepsy Risk Assessment (QMS-F056) EPILEPSY RISK ASSESSMENT (QMS-F056) Contact Document Ref: QMS-F056 (Epilepsy Risk Assessment) Version: 1.0 Confidentiality Level: HIGH (Medical Records) CQC Alignment: Safe (Emergency Procedures) Service User Full NameService User ID NumberOperating Local Authority- Select -HaringeyIslingtonWaltham ForestBarnetOtherCare Funding & Financial Arrangements- Select -Local Authority Managed (Direct Commissioning)NHS Funded (Continuing Healthcare - CHC)Direct Payments (Personal Budgets)Self-Funded (Full Cost)OtherSECTION 1 - Seizure Baseline & HistoryPrimary Seizure Classification- Select -Tonic-Clonic (Convulsive / Grand Mal)Focal / Partial (Aware or Impaired Awareness)Absence (Petit Mal)Atonic (Drop attacks)Myoclonic (Brief jerks)Unknown / Undiagnosed episodesFrequency of Seizures- Select -Multiple times a dayWeeklyMonthlyRarely (Less than once every 6 months)Well-controlled by medication (No recent seizures)Date of Last Known SeizureSECTION 2 - Triggers, Auras, and PresentationKnown Seizure Triggers Missed medication Lack of sleep / Fatigue Stress / Anxiety Flashing lights / Photosensitivity Fever / Infection Alcohol No known triggers identifiedDoes the service user experience an 'Aura' (warning sign) before a seizure?- Select -YesNoDescribe the Aura and Seizure PresentationSECTION 3 - Emergency Rescue ProtocolIs Emergency Rescue Medication / Equipment Prescribed?- Select -Buccal MidazolamRectal DiazepamVagus Nerve Stimulator (VNS) MagnetNone prescribedMandatory Scope of Practice Rule- Select -I confirm that Mutima Care staff will NOT administer this rescue medication without formal, documented, client-specific delegation and sign-off from an Epilepsy Specialist Nurse.999 Emergency Threshold (When must staff call an ambulance?) If seizure lasts longer than 5 minutes If it is their first ever seizure If one seizure follows another without full recovery If injury occurs during the seizure (e.g., hitting head) If breathing does not return to normal post-seizureSECTION 4 - Post-Ictal Care & InstructionsPost-Ictal (Recovery) Phase InstructionsEnvironmental Safety Precautions Showers only (No unsupervised baths) Ensure floor is kept clear of hard objects/clutter Use of fall mats beside the bed Use of a seizure alert monitor / wristband No specific environmental changes requiredAssessor NameDate of AssessmentSave Epilepsy Risk
