Use of a Pharmacy Management Service to Improve Adherence with Anti-Seizure Medication Level Lab Draws in Pregnant Patients with Epilepsy
Abstract number :
1.506
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2023
Submission ID :
1308
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Rachel Fahey, DO – Geisinger Medical Center
Raghuveer Puttagunta, MD – Geisinger Medical Center; Cynthia Correll, MD – Cayuga Health; Dana Vanino, DO – Geisinger Medical Center
Rationale: Pregnancy results in many physiologic changes which alter drug pharmacokinetics. Pregnant patients with epilepsy require regular monitoring of serum anti-seizure medication (ASM) levels to ensure they are on the most effective dose to prevent seizures. Generally, drug concentrations should be checked at a minimum of 5 times including pre-pregnancy, during pregnancy, and postpartum. Our institution has implemented a pharmacy management program since 2018 which assists with monitoring of drug levels and communicates directly with the treating provider and patient for ASM dosage adjustment needs. Clinical observation suggests that this quality improvement protocol may result in increased adherence to ASM level lab draws and the subsequent improvement in the safety of our pregnant patients with epilepsy overall.
Methods: This study is a retrospective chart review quality improvement (QI) project of female patients with an epilepsy diagnosis, on at least one anti-seizure medication, and with a pregnancy during the review period of 2014-2022. Patients were identified by the Epic Slicer Dicer tool as having a diagnosis of epilepsy by ICD-10 codes and an episode of pregnancy between the study period of January 2014 and December 2022. Once patients were identified, individual charts were reviewed to assess the adherence rates with ASM level blood draws in patients with epilepsy and pregnancy between 2014-2017, compared to patients with epilepsy and pregnancy who were referred to the pharmacy management service between 2018-2022. The minimum lab draws based on the protocol are: one pre-pregnancy, one each trimester, and one postpartum for a total of five lab draws.
Results: A preliminary group of 230 patients were identified as meeting study inclusion and exclusion criteria. Preliminary cohort data analysis of 50 patients showed an improved average lab draw adherence of 4.1 in the post-intervention group compared to 2.6 in the pre-intervention group. Complete chart review and data analysis remains in process at the time of this abstract submission.
Conclusions: We present a novel pharmacy management service for ASM drug level monitoring in pregnancy which may represent an effective strategy for improving adherence to recommended lab draws and subsequent safety in our pregnant patients with epilepsy.
Funding: No funding was received for this project.
Clinical Epilepsy