Abstracts

Rationale: The aim of this study was to identify gaps in the quality of epilepsy patient care in a 463 bed, tertiary hospital with an accredited, level 4 comprehensive epilepsy center. One measure identified was the frequency of delayed anti-epileptic drugs (AEDs) administered in our neurological institute between April, 2017 and April, 2019. To optimize patient care, two interventions were initiated. Data was collected and analyzed for changes in timing of AED administration. Methods: Data was collected on all patients who received AEDs from April, 2017 to April, 2019. Staff in the epilepsy monitoring unit (EMU) was chosen for the first intervention which included an announcement during every 12-hours shift change to administer AEDs timely between April 11, 2018 and May 23, 2018. As control groups, the other units did not receive an announcement. In May, 2019, a follow-up intervention was introduced and consisted of personal coaching for EMU staff who were consistently late (≥4% of total AEDs given) administering AEDs. To further assess causes for delayed administration, delays were divided into separate time increments of 60-90 minutes, 90-120 minutes, and > 120 minutes. Results: A total of 34,932 AEDs were administered in all units between April, 2017 and April, 2019 in a 463 bed, tertiary hospital with an accredited, level 4 comprehensive epilepsy center. We found 3,800 (11%) AEDs were administered late (all time increments). Reviewing data from separate units (neuro-ICU, medical unit, epilepsy monitoring unit, and neuro-oncology unit) revealed a close correlation between late AEDs administration and nursing staff retention rate. For example, one unit that experienced a 10% loss of nursing staff demonstrated a 4% increase of delayed AED administration. Units without high staff turnover did not show similar rates of delayed AED administration. Prior to April 2018, 11.9% of AEDs were delayed in the EMU. After the first intervention of shift change announcements, the percentage of delayed AEDs dropped to 10.4% in the first three months and continued to progressively decrease every quarter. The last quarter of the monitored period (February to April, 2019), it dropped to 7.6%. AEDs delayed between 60-90 minutes showed the most consistent improvement post-intervention, clearly tied to general nursing coaching. The nursing staff in the EMU who consistently delayed AED administration were further selected for personal coaching in May, 2019. We are in the process of collecting and analyzing the data post personal coaching intervention. Conclusions: Delayed AED administration can be an unappreciated common problem in inpatient care settings. Nursing staff turnover can exacerbate, but is not sufficient to account for the rates of delayed AED administration. Both general and personal coaching sessions are useful to increase compliance with timely AED administration. Funding: No funding