Abstracts

Rationale: The International League Against Epilepsy (ILAE) and the American Epilepsy Society (AES) have standard recommendations for the time of treatment of prolonged seizures. Despite these guidelines, there are deviations and delays in treatment initiation in clinical practice. There is paucity of research investigating delays in initiating home antiseizure medications (ASMs) in individuals with epilepsy admitted to the hospital. We hypothesized that there is a delay in administering home ASMs in the hospital setting.


Methods: Retrospective review of the electronic medical records (EMR) of epilepsy patients on ASMs either admitted to the General Neurology inpatient service or for whom primary teams consulted the Neurology service. One month data was collected. The EMR was reviewed for time of arrival to the emergency triage and time of home ASMs administration. The primary objective was calculated by finding the mean time from arrival to triage to time medication was scanned into the medication administration record (MAR). Neurology residents were then surveyed to see their estimation of difference in restarting home ASM in the inpatient setting between the two groups. They were then presented the data from the month and educated on potential causes of delay including timing of order placement, when they received loading dose, and reviewing outpatient medications. We then collected data for another month to monitor for improvement. Unpaired t-test was used to compare the inpatient and consult services, as well as the inpatient service before and after education.


Results: 17 patients fit the inclusion criteria over the time frame of the first month. 6 were admitted to the Neurology team and 11 patients were followed by the Consult service after a formal consultation was requested by the admitting services. The average time of to administration of home ASM on the Neurology service was ~5hours(h) and 30 minutes(min). The mean for the consulting services was 14h,6min. This difference was statistically significant (p-value of 0.0438 ; 95% CI -1015.19 to -16.61).

17 neurology residents were surveyed and educated prior to the second month of data collection. Their estimated time of home ASM in the absence of IV ASM was 5.765h for inpatient service and 11.765h for consulting services.

18 patients fit inclusion criteria for the second month (9 Neurology service, 9 Consult service). For the Neurology service, the time of arrival to triage to first home ASM administration was ~8h,6min. For the teams that neurology was a consulting service, the total time from arrival to triage to home ASM was ~7h,40min. There was not a significant statistical difference in the second month ( p-value = 0.8353).

There was also not a statistical difference between the Neurology service before and after education about potential delays in administration of home anti-seizure medications to patients (p-value of 0.1416).

The average time overall for the two groups combined was 9h,25min to home anti-seizure medication administration from arrival to triage.


Conclusions: We plan to assess if there is true delay by obtaining assessing further patients based on when last ASM was taken prior to arrival to hospital.


Funding: N/A