A protocol for status epilepticus in a long-term care facility using rectal diazepam (Diastat)

Area of Science:

• Geriatric Medicine
• Neurology
• Emergency Medicine

Background:

• Status epilepticus (SE) poses a significant risk to residents in long-term care facilities (LTCF).
• Intravenous benzodiazepines, the standard SE treatment, are often impractical in LTCFs due to staffing and patient factors.
• Alternative methods for rapid SE treatment are crucial for this vulnerable population.

Purpose of the Study:

• To describe a protocol for managing SE in an LTCF using rectal diazepam gel.
• To evaluate the feasibility and effectiveness of this alternative treatment approach.

Main Methods:

• Development of a specific SE protocol at Badger Prairie Health Care Center (BPHCC).
• Utilization of rectal diazepam gel (Diastat) when intravenous access was unavailable.
• Inclusion of a plan for initiating long-term anticonvulsant therapy post-SE treatment.

Main Results:

• The BPHCC protocol was successfully implemented eight times between August 1999 and November 2000.
• The article details the protocol and presents three representative case studies.
• Rectal diazepam proved to be an effective method for acute SE management in the LTCF setting.

Conclusions:

• Rectal diazepam gel offers a viable and effective alternative for treating SE in LTCF residents.
• The protocol facilitates timely intervention, potentially preventing neuronal damage and improving patient outcomes.
• This approach addresses the challenges of administering intravenous medications in the LTCF environment.