Abstracts

Rationale: Adherence to antiepileptic drugs (AEDs) is essential for seizure control and can potentially prevent serious consequences of seizures. Timely administration of AEDs in the inpatient setting is similarly important to adherence in the outpatient setting. We sought to study the timeliness of initiation and administration of AEDs in epilepsy patients admitted to our institution. Methods: A retrospective review of 500 patients' electronic charts admitted with a diagnosis of 'seizures', 'epilepsy' or 'convulsions', over a 3 month period, was performed. Patient admission-time was compared to AEDs initiation-time. These times were then compared across different services and factors contributing to delay in therapy initiation were analyzed. Results: Among the various services, 100 patients were admitted to the surgical services, 170 to the neurology services and 230 to medical services. On the surgical teams, 90% (90/100) and 10% (10/100) patients had their AEDs ordered by the pharmacists and residents respectively. On the neurology teams, 88% (150/170) and 12% (20/170) patients had their AEDs ordered by residents and pharmacists respectively. While on the medical teams, 22% (50/230), 48% (110/230) and 30% (70/230) patients had AEDs ordered by attending physicians, residents and pharmacists respectively. On the neurology teams, 82% (140) patients had AEDs started within 6 hours. On medical teams, 17% (40) patients had AEDs initiated within 6 hours while 70%(160) had their home treatment initiated within 6-24 hours post-admission. On the surgical teams, 50% (50) patients had AEDs started after 24 hours post-admission while only 10% (10) had AEDs started within 6 hours. Common cause of delayed AED initiation included waiting for medicine reconciliation, altered mental status, and absence of collateral information regarding treatment from relatives at the time of admission. Consultation of ancillary services resulted in the greatest delay in initiation of home therapy. Conclusions: Patients were most likely to have their AEDs ordered, after admission, in less than 6 hours if the ordering staff was part of the admitting team. Evaluation by multiple teams prior to admission contributed to delays in initiation of therapy. Delays in AED initiation can have a negative impact on patient's outcome, increase morbidity, and affect hospital length of stay should patients experience additional seizures during their hospitalization. Several strategies could overcome this delay. Staff education about the importance of timely initiation of AEDs would be helpful. Epilepsy patients' should be encouraged to carry an updated list of their AEDs with dosing as well as their pharmacy's information. Funding: None