Abstract Details

The American Epilepsy Society Guidelines recommend benzodiazepines (BZ) as first line treatment for seizures lasting greater than 5 minutes and loading antiseizure medications (ASM) in a 20–40-minute window. Delay and underdosing the initial treatment of SE is associated with longer duration of seizures, increased hospital stay, morbidity and mortality. The initial phase of our QI project found that at our institution the main barriers were lack of knowledge of treatment guidelines for SE, timely communication with pharmacy and nursing, and preparation of intravenous ASMs.

To establish interventions that address barriers to improve the treatment of status epilepticus (SE) at Geisinger Medical Center.

We implemented the following interventions: 1) educate prescribers in the neurology, emergency medicine, and critical care departments regarding the approved institutional protocol for SE and availability of an orderset with optimal dosing, 2) two-factor communication regarding SE medication orders to nursing and education of nursing and pharmacy staff regarding target administration times, 3) add ready-to-mix levetiracetam to nurse omnicells on high-volume floors, and 4) update the SE orderset to improve usability across multiple departments. We compared the use of appropriate doses of ASMs and time to administration of ASMs before and after the interventions. We analyzed data 9 months after the interventions.

Our resident-driven QI project led to improvement in dosing and timing of administration of BZ and second line ASMs. BZ dosing continues to be a major area for improvement.