Abstracts

Rationale: Pharmacologically refractory epilepsy accounts for approximately one third of the epilepsy patients in the United States. The vagus nerve stimulator is a well studied and established effective treatment for refractory epilepsy. Once the decision has been made to proceed with implantation, and surgery is complete a new set of challenges can occur. The vagus nerve stimulator needs to be programmed and titrated until it reaches a therapeutic level for the patient. This process can take months, and is traditionally done by the Epilepsy provider. The challenges to the patient and the provider once the vagus nerve stimulator is placed include limited access to available provider appointments, delay in reaching a therapeutic level, increased cost to the patient for provider appointments. Methods: In 2010, a level IV Pediatric Epilepsy Center established a protocol allowing nurses to autonomously program and titrate vagus nerve stimulators. This protocol allows for nurses, with specialized training, to provide care for the growing number of refractory epilepsy patients with vagus nerve stimulators. An independent Vagus Nerve Stimulator Clinic was established in 2012 that allowed nurses to program and titrate based on a provider approved protocol. Results: Since the Vagus Nerve Stimulator clinic was instituted over 400 vagus nerve stimulator nurse led titrations have been completed. The Vagus Nerve Stimulator clinic is available 5 days a week with frequent same day and next day availability. This clinic has led to increased access to care for the patients, Improved patient satisfaction, and decreased delays in reaching a therapeutic titration level. Conclusions: All Epilepsy Centers should consider having a nurse led Vagus Nerve Stimulator Program including a protocol and clinic. Instituting this protocol and clinic leads to benefits for both the patient and the provider. This protocol provides nursing autonomy and professional leadership development, while giving patients increased access to care and overall satisfaction. This results in better overall care for the refractory epilepsy patient.