Abstracts

Rationale: Status epilepticus (SE) is a neurological emergency where early treatment is essential. In a previous study performed at our institution, we found markedly prolonged times to administration (TTA) of second-line antiepileptic drugs (AEDs) for patients in SE (1). Delays in AED administration were also reported by the Pediatric SE Research Group (2).  We evaluated whether implementation of a SE alert protocol could improve TTA of second-line AEDs in this patient population. Methods: A quasi-experimental cohort study was performed in our institution to evaluate mean TTA of second-line AEDs to patients in electroclinical SE. After establishing baseline TTA (Cohort 1) (1), an Intervention was implemented consisting of hospital staff education and creation of an electronic order set for acute management of SE (Cohort 2) (3). Next, a SE alert protocol was developed (Cohort 3). When a patient in clinical SE is identified, staff notify Central Monitoring. Then, Central Monitoring simultaneously pages the general neurology resident, the pharmacist, and the neurointensivist on call, in addition to the rapid response team (RRT) and the house officer. The page reads “Status epilepticus alert”, followed by the patient’s location.  In this SE alert protocol, the neurology resident performs a clinical evaluation, enters orders for AEDs, determines need for EEG and neuroimaging, and oversees patient management. The pharmacist verifies orders and dispenses AEDs to the patient’s bedside. The neurointensivist and RRT evaluate airway and perform endotracheal intubation if necessary. The house officer is notified for bed assignment purposes in the event that escalations in level of care are required. Cohorts were compared using descriptive statistics and t-test for TTA of second-line AEDs. Results: Cohort 1 (n=25) had an average TTA of a second line AED of 71 minutes (SD 59) (1). TTA for Cohort 2 (n=7) was 82 minutes (SD 32) (3). There was no significant difference in TTA of second-line AEDs once the Intervention was implemented (p=0.6414). Cohort 3 (n=19) had an average TTA of a second-line AED of 19.05 minutes (SD 11.07). TTA was significantly improved when compared to the initial pre-Intervention TTA (Cohort 1, p=0.0005), and to TTA following our Intervention consisting of house staff education and creation of a SE electronic order set (Cohort 2, p < 0.0001). The most common second-line AEDs used in these 19 patients were levetiracetam (n=9) and fosphenytoin (n=6). Data collection is ongoing. Conclusions: This SE alert protocol has led to marked improvement in TTA of second-line AEDs, resulting in earlier initiation of therapy after benzodiazepines for patients in SE. To the best of our knowledge, similar SE alert protocols have not been published. Funding: No funding.REFERENCES1. Boske AC, A.; Bensalem-Owen, M. Assessment of Time of Administration from Time of Order of Anti-Epileptic Drugs in Status Epilepticus. Neurology 2013;80: Supplement S48.0072. Sanchez Fernandez I, Abend NS, Agadi S, et al. Time from convulsive status epilepticus onset to anticonvulsant administration in children. Neurology 2015;84:2304-2311.3. Callow et al. Assessment of the Timeliness of Administration of Second Line Antiepileptic Drugs for Status Epilepticus after the Implementation of a Status Epilepticus Bundle Order Set: A Single Institution Experience. Neurology 2015;84: Supplement P7.322