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Optimizing anticonvulsant administration for children before anesthesia: a quality improvement project.
Charlotte T Jones1, Vidya T Raman2, Seth DeVries3
1Division of Child Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Pediatric Neurology
|September 7, 2014
Summary
Children with epilepsy often miss anticonvulsant medications during hospital transitions, risking seizures. A quality improvement project successfully increased scheduled anticonvulsant administration before anesthesia procedures, improving patient safety.
Area of Science:
- Pediatric Neurology
- Quality Improvement in Healthcare
- Medication Safety
Background:
- Children with epilepsy face heightened risks of missed anticonvulsant doses during hospital transitions.
- This medication gap can lead to lowered anticonvulsant levels and breakthrough seizures, particularly before procedures requiring anesthesia.
Purpose of the Study:
- To implement an interdisciplinary quality improvement project aimed at increasing the administration rate of scheduled anticonvulsants for children with epilepsy before procedures requiring anesthesia.
Main Methods:
- Utilized the Institute for Health Care Improvement methodology to form an interdisciplinary team.
- Standardized medication administration protocols for patients with 'nothing per os' (NPO) status before anesthesia.
- Developed a contingency plan for managing missed home anticonvulsant doses.
Main Results:
- The percentage of children receiving scheduled anticonvulsants at home before anesthesia procedures rose from 76% to 90% (P = 0.002).
- In-hospital administration of maintenance anticonvulsants before procedures increased significantly from 21% to 91% (P < 0.001).
Conclusions:
- Quality improvement initiatives effectively enhanced the continuity of anticonvulsant medication during the home-to-hospital transition for pediatric epilepsy patients.
- Sustaining these improvements necessitates ongoing efforts and active parental involvement in care transitions.
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