Abstracts

Rationale: To establish whether the interventions carried out in 2022 at our institution that addressed barriers to improve the treatment of status epilepticus (SE) were sustainable or not. We had carried out interventions in 2022 to reduce the time to administer ASM in patient with SE and ensure appropriate dosing. This study aims to assess longevity and impact of intervention in long term. In addition we aim to assess which interventions were useful and which were not. This data will also help us in guiding future efforts to improve treatment of SE.

The interventions included :
1. Educating prescribers in neurology, emergency medicine and critical care medicine departments,
2. Prepare ready-to-mix Leviteracetam in automated cabinets for nurse to use
3. Updated the order set to improve usability and ensure appropriate dosing of ASM
4. Two-factor communication regarding SE medication orders to nursing



Methods: Of the 48 patients that were treated in our ED for status epilepticus, we noted the time of order and administration of 1st and 2 line ASM and their respective dose. I compared the current data (2023) with the prior data (2021 and 2022).

Informal interviews were also conducted with various providers in the ED, pharmacists, ED nurses and neurology residents to collect information of aforementioned interventions.

Results: In 2021, prior to intervention, average duration of time from order to administration was 10-14 minutes for 1st line ASM and 87 minutes for 2nd line ASM. After intervention in 2022 the average duration was 9 minutes (1st line) and 45 minutes for (2nd line). The average duration in 2023 for 1st line ASM was 4 minutes and for 2nd line ASM was 36 minutes.

However the rate of appropriate dosing has remained poor. ED residents collectively stated they did not know the order set existed.

0 out of the current 16 neurology residents consistently communicate with nursing and pharmacy.
On manual review of all charts, we also noted that the appropriate dosing of 1st line ASM an uncontrollable factor as majority of patient's receive it en-route to the ED.

Conclusions: Out of the 4 interventions, 1 is believed to have made an impact and that is the addition of pre mix/ ready-to-mix Leviteracetam in automated machines. This has led to reduced time to administer ASM once ordered (now within the AES guidelines) and this change is reflected even in 2023. Based on the current data it proves that the intervention was sustainable, effective and viable. However the other interventions were unsustainable and the primary reason being the change in resident group every year and was reliant on individuals rather than system. In future, we are now focused on addressing the appropriate dosing of ASM. We believe an updated order set will help us achieve that goal.

We are currently working on updating the order set to make it more user friendly and we have re-educated the ED residents on the use of order set for SE. We are hopeful that with regular usage of order set, the appropriate dosing percentage will increase and aim is to reach 100% appropriate dosing of 2nd line ASM.

Funding: None