Abstracts

Rationale: In 2010, a Task Force of the Commission of Pediatrics developed a consensus document about treatment of children with infantile spasms (IS) suggesting that evidence based guidelines for the management of infants with seizures are lacking, and that guidelines that clarify the optimal management of seizures in the infantile period are essential for all healthcare providers treating children with IS. Misdiagnosis of IS is potentially catastrophic, with unsuccessful treatment associated with devastating neurodevelopmental arrest and enduring epilepsy.The purpose of this Quality Improvement project was to implement a guideline and electronic medical record order set for inpatient neurology providers at Ann and Robert H. Lurie Children's Hospital caring for patients with IS and to evaluate its impact on patient length of stay, time to first dose of seizure medication, and inpatient healthcare providers compliance to the guideline with use of an audit tool. Methods: An IS work group was created with a goal of generating a guideline on the evaluation, treatment, monitoring, and follow up of patients with infantile spasms. After a review of several consensus papers, outside hospital IS guidelines, and professional experience, a new guideline and electronic medical record order set were implemented. A retrospective chart review was completed to evaluate patient length of stay, time to first dose of medication, and adherence to guideline by inpatient healthcare providers before and after the guideline and order set was implemented. An investigator generated tool titled 'Infantile Spasms Adherence Tool' included adherence evaluation items including 1) Patient was prescribed a first line treatment for IS 2) Patient received all etiological diagnostic tests recommended by guideline 3) Patient had a scheduled follow up appointment 12-21 days after first medication dose and 4) Patient had medication dosing schedule listed on their discharge instructions. Results: 12 patient charts were reviewed after the guideline and electronic medical record order set were implemented and were compared to an equal number of 12 patient charts prior to implementation. There was a statistically significant decrease in patient length of stay by 1.1 days, decreased time to first dose of medication by 7.2 hours, and overall increase in provider adherence scores in all audit evaluation items. Conclusions: Worldwide there is a lack of current evidence based guidelines available for providers in an inpatient setting for specific syndromes including IS. This can lead to greater variability in treatment and higher risks for patients due to inaccurate management. As a result, health care providers may not be adequately prepared to care for vulnerable populations such as infants with IS. Establishing current evidence based practice guidelines for inpatient specialty settings and choosing an effective implementation strategy to educate inpatient healthcare providers are first steps toward improving the care of patients with IS. Funding: No funding