Reducing seizure to needle times in nonconvulsive status epilepticus with multifaceted quality improvement initiatives

Navnika Gupta; Hae Y Baang; Wattana Barrett; Katharine Reisbig; Kayli A Bendlin; Scott A Coleman; Kaeli Samson; Olga Taraschenko

doi:10.1016/j.eplepsyres.2023.107085

Reducing seizure to needle times in nonconvulsive status epilepticus with multifaceted quality improvement initiatives

Epilepsy Res. 2023 Feb:190:107085. doi: 10.1016/j.eplepsyres.2023.107085. Epub 2023 Jan 11.

Authors

Navnika Gupta¹, Hae Y Baang¹, Wattana Barrett¹, Katharine Reisbig², Kayli A Bendlin², Scott A Coleman², Kaeli Samson³, Olga Taraschenko⁴

Affiliations

¹ Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
² Acute Care Pharmacy, Nebraska Medicine Hospital, Omaha, NE, USA.
³ Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA.
⁴ Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: olha.taraschenko@unmc.edu.

Abstract

Objectives: Delayed management of nonconvulsive status epilepticus (NCSE) can lead to an increased morbidity and mortality. We previously established that inefficient treatment of NCSE at our institution stemmed from delayed initiation of emergent anti-seizure medications (ASM). In the present study, we assessed the trajectories of these time parameters and determined patient outcomes following the specific quality improvement (QI) interventions.

Methods: The QI interventions, including the revision of the educational content for trainees and pharmacy workflow optimization were implemented between January 2019 and September 2021 by a dedicated multidisciplinary task force. The times needed to initiate and administer the ASMs for patients with NCSE as well as patient mortality were assessed in comatose and noncomatose patients and compared with the corresponding values prior to the interventions.

Results: There were 79 occurrences of NCSE in 74 patients. The median time from seizure detection on EEG to the order of the first and second ASM for NCSE was reduced by 4 (p = 0.83) and 8 min (p = 0.52), respectively compared to the times prior to the initiation of interventions. The median times from the order to administration of the first and third ASM for all NCSE occurrences were reduced by 8 and 10 min, respectively (p = 0.28 and p = 0.10). In the present cohort of comatose patients, the median time spent to order the first ASM was reduced by 16.5 min and the time to administer it reduced by 35 min compared to that in our previous study. The overall patient mortality was decreased by 11.1%.

Significance: More efficient delivery of rescue ASMs in patients with NCSE and improvement in their mortality can be achieved with multidisciplinary team efforts aimed at streamlining the functioning of pharmacy and strengthening the education of trainees and nurses.

Keywords: Anti-seizure medications; Medication delivery; Medication order set; Quality improvement; Resident education; Status epilepticus.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Cognition
Coma* / diagnosis
Electroencephalography
Humans
Quality Improvement
Status Epilepticus* / diagnosis

Grants and funding

P20 GM130447/GM/NIGMS NIH HHS/United States