Improving Adherence to Guidelines When Treating Status Epilepticus: A Quality Improvement Project
Abstract number :
3.212
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2021
Submission ID :
1825551
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
Kelsey Smith, MD - Mayo Clinic; Benjamin Cox, MD - Mayo Clinic; Shaun Ajinkya, MD - Mayo Clinic; Jaclyn Jacobi, MD - Mayo Clinic; Gamaleldin Osman, MBBCh - Mayo Clinic; Jae Lee, MD - Mayo Clinic; Hugh Simpson, MBBS, PhD - Mayo Clinic; Mayur Chalia, MBBS - Mayo Clinic; Ausaf Ahmed, MBBS - Mayo Clinic; Stephen English, MD, MBA - Mayo Clinic; Sarah Clark, PharmD, BCPS, RPh - Mayo Clinic; Jeffrey Britton, MD - Mayo Clinic; David Burkholder, MD - Mayo Clinic; Lily Wong-Kisiel, MD - Mayo Clinic; Sara Hocker, MD - Mayo Clinic; Andrea Leep-Hunderfund, MD - Mayo Clinic
Rationale: Status epilepticus (SE) is a neurologic emergency with a mortality rate of 10%. Data suggests that antiseizure medication (ASM) dosages are not consistently adequate in management of SE, which can affect outcome. The objective of this study was to analyze and improve adherence to guidelines for the treatment of SE in adults.
Methods: We utilized the DMAIC (Define, Measure, Analyze, Improve, Control) model of process improvement to improve adherence to guidelines in management of SE. Baseline adherence to guidelines was determined by analysis of a database of adult patients with SE in St. Mary’s Hospital neurology and non-neurology intensive care units (Mayo Clinic, Rochester, MN) from 2011-2016. We discussed the current process of treatment of SE with multiple stakeholders, including residents, staff neurologists, pharmacists, and nursing to determine areas of improvement and optimal intervention strategy.
Results: Baseline data was analyzed from 184 patients with convulsive SE. The majority of patients (n=170, 92.4%) received benzodiazepines first but were under-dosed ( < 4 mg of lorazepam or equivalent benzodiazepine) in 45.3% (77/170). Appropriate ASMs were started in the majority (n=179, 97.3%) but under-dosed in 33/179, 18.4%. Stakeholders noted that there was unfamiliarity with current guidelines, delays in dispensing medications, and concerns for sedating effects of benzodiazepines. To increase adherence to guidelines, an order set was created in our electronic medical record that provides the appropriate weight-based dosing of first- and second-line medications, as well as ancillary lab tests that may be useful in SE. Education sessions were then implemented to teach residents and medical students (during neurology and internal medicine rotations) about the proper treatment of SE and the order set. Approximately 100 learners attended these sessions, and the overall feedback was positive. In the 4 months prior to the education sessions, the order set was used 8 times; in the 4 months post education sessions, the use increased to 17 (213% increase). Future plans for the project include increasing education sessions to target health care providers in the emergency department and rapid response teams and implementing similar order sets for the treatment of pediatric and neonatal SE.
Conclusions: SE is a neurologic emergency that requires prompt and appropriate treatment. Baseline data revealed that medications for SE are frequently under-dosed. Implementing a standardized order set accompanied by targeted education improves inherence to guidelines for SE.
Funding: Please list any funding that was received in support of this abstract.: None.
Clinical Epilepsy