Improving on Time Anticonvulsant Administration During the Home-to-Hospital Transition
Annals of Neurology
Objective: Children with epilepsy are at increased risk of missing scheduled anticonvulsants during the home to hospital transition.1,2 Missing anticonvulsants during this transition has been associated with an increased risk for breakthrough seizures and the consequences of seizures.3 It is a national standard of care that children receive their anticonvulsants even while NPO. We undertook a quality improvement project to improve anticonvulsant administration during the home to hospital transition for children with epilepsy under gong procedures under anesthesia.
Methods: Using the methodology of the Institute for Health Care Improvement we created Key Driver Diagrams and undertook interventions based on these drivers. Major interventions included increasing awareness of the problem, feedback on our successes and failures and education on medications administration and alternatives when children are NPO.
Results: We have increased the percentage of children receiving their anticonvulsants prior to procedures requiring anesthesia from 76% to 88% (p value 50.02). We increased from 23% to 91% (p value5 .0001) the number of children who received their anticonvulsant in the hospital prior to their procedure who had not received it at home. (Graph Attached)
Conclusion: Using a team based approach with anesthesiology and neurology will were able to significantly improve anticonvulsant administration for children with epilepsy during the home to hospital transition. Missed anticonvulsant administrations during the home to hospital transition can and should be prevented and we have demonstrated that using accepted quality improvement methodology they can be. Our success can provide guidance for addressing this problem
1. Coffey M, Mack L, Streitenberger K, Bishara T, De Faveri L, Matlow A. Prevalence and clinical significance of medication discrepancies at pediatric hospital admission. Acad Pediatr. Sep-Oct 2009;9(5):360–365 e361.
2. Jones C, Missanelli M, Dure L, et al. Anticonvulsant medication errors in children with epilepsy during the home-to-hospital transition. J Child Neurol. Mar 2013;28(3):314–320.
3. Jones C, Kaffka J, Missanelli M, et al. Seizure Occurrence Following Nonoptimal Anticonvulsant Medication Management During the Transition Into the Hospital. J Child Neurol. Oct 3 2012.
Epilepsy and other paroxysmal disorders, translational/experimental therapeutics
Jones, C.; Raman, V. T.; DeVries, S. P.; Cole, Justin W.; and Tobias, J., "Improving on Time Anticonvulsant Administration During the Home-to-Hospital Transition" (2013). Pharmacy Practice Faculty Publications. 296.