Abstracts

Rationale: Prescribing errors occur during as many as 50% of hospital admissions.¹ Epilepsy patients who miss antiepileptic drug (AED) doses due to medication nonadherence are at risk for seizures.² The prevalence of in-hospital medication errors raises concern that outpatient AEDs may often be delayed, missed, or changed in hospitalized epilepsy patients, and that these errors may increase patients’ risk of seizures. No published data exist describing the frequency of AED errors in the inpatient setting or their association with seizures. Methods: Epilepsy patients treated in the Columbia University Medical Center (CUMC) epilepsy fellows’ clinic who were admitted to CUMC between January 2013 and December 2017 were identified via retrospective chart review. For each admission, time from admission to first AED dose, number of missed AED doses, inpatient AED regimen and whether or not it was changed from the patient’s home regimen, and presence or absence of seizures were recorded. Percentage of admissions with delayed or missed AED doses, changes from the patient’s home AED regimen, and seizures were calculated. Univariate logistic regression analysis was performed to estimate the association between the occurrence of seizure during admission and the presence of missed AED doses, changes from the patient’s home AED regimen, and preadmission seizure frequency. Results: Among 207 patients identified, 24 patients had one or more admissions (11.6%). A total of 54 admissions were identified, with a mean length of 5.89 ± 5.22 days. Initial AED dose was delayed by more than 2 hours during 34 admissions (63.0%). At least one AED dose was missed during 30 admissions (70.4%). Two or more AED doses were missed during 29 admissions (50.7%). Patients were treated with their home AED regimen during 45 admissions (83.3%). Seizures occurred during 8 admissions (14.8%). Missed AED doses, changes from the patient’s home AED regimen, and preadmission seizure frequency were not significantly associated with increased likelihood of seizure (Table 1). Conclusions: While most epilepsy patients were treated with their home AED regimens while admitted, delayed and missed AED doses were common. An increased risk of seizure was present among patients who missed at least one AED dose, though this association did not reach statistical significance, possibly due to inadequate power. Missed AED doses should be avoided during hospitalizations.¹Lewis PJ, Dornan T, Taylor D, Tully MP, Wass V, Ashcroft DM. Prevalence, incidence and nature of prescribing errors in hospital inpatients: a systematic review. Drug Saf. 2009;32(5):379-389.²Cramer JA, Glassman M, Rienzi V. The relationship between poor medication compliance and seizures. Epilepsy Behav. 2002;3(4):338-342. Funding: None