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Improving time for administration of second-line antiseizure medications for children with generalized convulsive
Jorge Vidaurre1, Dara V F Albert1, William Parker2
1Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus, Ohio, USA.
Insights
Quality improvement initiatives successfully reduced the median time to administer fosphenytoin for pediatric status epilepticus. This critical intervention for generalized convulsive status epilepticus now takes significantly less time, improving patient care.
Area of Science:
- Neurology
- Pediatrics
- Quality Improvement Science
Background:
- Status epilepticus is a critical neurological emergency requiring prompt treatment.
- Delays in administering second-line antiseizure medications, such as fosphenytoin, prolong seizure activity.
- Optimizing treatment timelines is crucial for improving outcomes in pediatric status epilepticus.
Purpose of the Study:
- To decrease the average delay in fosphenytoin administration for pediatric generalized convulsive status epilepticus.
- To reduce the time from 30 minutes to 15 minutes by December 2015 and sustain the improvement.
- To implement quality improvement strategies to expedite second-line medication delivery.
Main Methods:
- Analysis of baseline data for pediatric patients receiving fosphenytoin after benzodiazepine failure.
- Application of quality improvement methodologies to identify and address delays.
- Implementation of interventions aimed at a 15-minute target for fosphenytoin initiation.
Main Results:
- The average time to fosphenytoin administration decreased from 30 minutes to 11.4 minutes (a 62% reduction).
- This reduction was statistically significant (p = .043).
- The study included 199 pediatric patients (1 month to 19 years).
Conclusions:
- Quality improvement methodologies are effective in reducing administration time for second-line antiseizure medications.
- Successful implementation can significantly decrease delays in treating status epilepticus.
- This approach enhances the timely delivery of critical care for pediatric neurological emergencies.
Objective:
Status epilepticus is a life-threatening neurological emergency. However, delay in median time to administration of second-line antiseizure medication exists. The aim of this quality improvement initiative was to decrease the average delay before fosphenytoin is administered for pediatric patients with generalized convulsive status epilepticus from 30 min (baseline data collected in 2013) to 15 min (50% reduction) by December 2015 and sustain this for 1 year.
Methods:
Our team conducted an analysis of baseline data for patients with continuous generalized convulsive status epilepticus who received fosphenytoin after receiving first-line benzodiazepine treatment. Using quality improvement methodology, areas for improvement were identified and specific interventions developed and implemented. A timeline of 15 min to initiate fosphenytoin administration after failure of first-line treatment was considered reasonable and achievable as a project aim.
Results:
A total of 199 patients were included in the dataset for the project. The database included patients aged 1 month and older. Ninety-eight percent of patients were between 1 month and 19 years of age. The gender distribution was even, with 54% of patients being White or Caucasian, 30% African American or Black, and 16% classified as "other." From January 2014 through December 2019, the average time before initiating fosphenytoin administration after failure of benzodiazepine therapy, for patients with generalized convulsive status epilepticus, decreased from 30 min (SD = 45.7) to 11.4 min (SD = 8.2, p = .043), thus reducing time to administration by 62%.
Significance:
Quality improvement methodology can be successfully applied to decrease administration time between first- and second-line antiseizure medications for status epilepticus.
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