Abstracts

Rationale: Status Epilepticus (SE) is a state of prolonged or repeated seizures without regaining consciousness. Every minute of medication delay during a seizure increases chances of prolonged seizure by 5%, putting the patient at risk of permanent brain damage and loss of function after ten minutes. SE patients experience refractory seizure clusters even despite preventative measures such as daily medication adherence and trigger avoidance. Rescue therapies (RT) in these scenarios include anticonvulsant medications delivered through oral, intrabuccal, nasal or rectal pathways, requiring extensive and efficient medication administration education. Less than half of patients who experience seizure clusters actually receive RT at all, let alone in a timely enough manner to minimize complications. The Epilepsy Foundation’s new preferred practice for better SE patient outcomes is implementation of a Seizure Action Plan (SAP), a document that personalizes instructions and medication information for patient caregivers. The primary aim of SAPs is preventing hospital admission, loss of function, and allostatic load on both the patients and their caregivers. This could contribute to reduction of the annual 1 million Emergency Department visits and $2.5 billion hospital costs attributed to Epilepsy. This pilot study investigates the feasibility and optimization of institutional use of a SAP adapted for BNI.

Methods: A SAP for SE patients was built for BNI based on feedback from focus groups and patient interviews. The focus groups consisted of two rounds, one with the epileptologists on the BNI team, and one with the Medical Assistants and Registered Nurses. Based on the focus groups, a current state process map (fig. 1) was created to understand the steps taken from diagnosis to receiving RT. Based on the established process map, patient and caretaker perspectives were acquired through phone interviews. After synthesis of the data from patients, caretakers, and providers, a pilot of the SAP was assembled for testing from the Epilepsy Foundation’s previously untested template. Five patients received SAPs filled out by their physician. Feedback was systematically acquired throughout the pilot about both the process of filling out and delivering the SAP from providers and about receiving the plan from patients/caregivers.

Results: Trial completion and distribution of the SAP showed need for this intervention. The education sessions lasted 25-50 minutes despite previous experience with rescue medications by the patients and caregivers. Participants found the SAP and education specifically to increase feelings of safety, panic reduction, and understanding of medication administration. The SAP, if standardized, is capable of producing tangible improvement outcomes for patients. Recommendations for improvement are indicated in the full analysis.

Conclusions: This pilot study was a success, and signals both feasibility and need to progress with rollout of the tool developed for this study at BNI. This study also provides an example for similar institutions to follow in the methodology of testing and rollout of SAPs customized to their patient populations and needs.

Funding: Please list any funding that was received in support of this abstract.: N/A.