Abstracts

Rationale: The Alberta Children's Hospital Children's Comprehensive Epilepsy Center (CCEC) has endeavoured to improve the quality of care through the use of QI (quality improvement) methodologies. The development and implementation of anti-seizure medication treatment pathways is one of the ways of standardizing care and reducing clinical practice variation. This is particularly true where there is limited evidence base to guide clinical decision-making such as the best way in which to upwardly titrate anti-seizure medication doses and for the maximum dosing of these medications in the paediatric population. We report the lessons learned in the development of a levetiracetam (LVT) pathway. Methods: The CCEC team (clinical nurse specialist, staff nurses, epileptologists, neuropsychologist, pharmacist) drafted a pathway to facilitate the standardized prescribing of LVT for epilepsy based upon available evidence & consensus among practitioners (see Figure). The LVT pathway was implemented in January of 2014. Staff using the pathway was expected to keep a record of all patients for whom the LVT pathway is initiated and document the rationale for pathway "deviations" as needed Results: The levetiracetam pathway was readily adopted by the neurology care team as it allowed continuity of care between providers and allowed families to get instructions with a single phone call to nursing staff. Lessons learned from this pathway development and implementation work include: 1. It is critical to be clear as to define the end user: e.g. general neurology clinic nursing and neurologist staff, epileptologists, and general pediatricians 2. It is important to confirm that independent pathway use by clinic nursing and pharmacist staff is within their respective scopes of practices 3. The need for early agreement on development software (PowerPoint?(R)), formatting standards and dissemination formats (.PDF, portable document format) assisted with improved information flow, readability and utilization. 4. A single page limit encompassing both pathway and auxiliary dosing information helps with adoption 5. Ready access to a central shared drive housing electronic versions facilitates uptake 6. It is important to pay attention to basic housekeeping details such as including time stamps of updates made on each pathway draft to ensure users have the most current versions 7. Adopting a formal evaluation tool (Google?(R) Form) as per the Plan-Do-Study-Act model to ensure standardized pathway use, and to capture recurring prescribing and management variations to inform future pathway optimization and construction contributes to continuous quality improvement 8. Ensuring that newer pathways are officially implemented only after thorough alpha testing, informs modifications and final approval by the CCEC 9. It is important to avoid overburdening CCEC staff charged with pathway creation and to "share the load" Conclusions: The creation and implementation of an anti-seizure drug pathway can be facilitated by the structure and processes prescribed by QI roadmaps especially in the context of a committed co-creating team (CCEC). Funding: n/a