Abstracts

Rationale: The timely administration of medications in NCSE is critically important for improving patient outcomes. We previously reported at our institution that the administration of first and second anti-seizure medications for NCSE was delayed. The delays were compounded by inefficient initiation and completion of orders for emergent antiepileptic drugs (AEDs). Therefore, over the course of 29 months, we introduced a series of quality improvement (QI) initiatives aimed to facilitate the processing and execution of medication orders by physicians, pharmacists, and nursing staff. We reassessed the efficiency of the medication delivery process and compared the drug administration times with those previously recorded.

Methods: This is a retrospective chart review and analysis of all consecutive adult patients with NSCE admitted to the University of Nebraska Medical Center, a level 4 epilepsy center, between January 1, 2019 and May 9, 2021. During this time, the following QI measures were introduced: placement of the supply of lacosamide and levetiracetam into an Omnicell medication dispensing system on the Neurology and Neuro-intensive care floors, implementation of a status epilepticus (SE) medication order set, and development of a mandatory course for neurology nurses on care for patients with seizure emergencies. At the conclusion of the study period, these initiatives had been in place for 29, 21, and 8 months, respectively. Time of seizure onset and times of AED administration were extracted from procedure reports and pharmacy logs notes, respectively. NCSE was defined as an electrical epileptic activity that lasted longer than 30 minutes or a series of nonconvulsive seizures totaling 30 min in 1 h without complete clinical recovery between the episodes. All occurrences of convulsive SE and post-anoxic/myoclonic SE were excluded.

Results: A total of 103 orders for rescue AEDs were placed for the management of 46 episodes of NCSE in 46 patients. Of these orders, 50 (51.5 %) were placed using the SE medication order set. The time from NCSE detection to order of the first anti-seizure drug was 42.5 min, reflecting a 9.6% decrease compared to the corresponding time previously reported at our center. Time from the order to administration of the first anti-seizure medication was 18 min, (18.2% decrease), and time from seizure detection to order of the second medication was 59 min (12% decrease). There were no statistically significant differences between the present and previously reported latencies.

Conclusions: Implementation of several health care initiatives at our comprehensive epilepsy center has resulted in improved processing of emergent orders for rescue medications and allowed for more efficient delivery of medications to the bedside. Although the differences between current and previously recorded latencies did not reach statistical significance, these results are encouraging and suggest that the education of resident, nurses, and pharmacy staff can improve the care for patients with NCSE.

Funding: Please list any funding that was received in support of this abstract.: O.T. received the AES Junior Investigator Research Award and AES-NORSE Seed Grant.