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Adherence to Prophylactic Anticonvulsant Guidelines for Newly Diagnosed Brain Tumor Patients: A Quality Improvement
Dan Beverly Fu1, Xiao-Tang Kong1, Tener Goodwin Veenema2
1University of California Irvine, School of Medicine, Irvine, California.
Insights
Adherence to prophylactic antiepileptic drug (AED) guidelines for brain tumor patients significantly improved after a quality improvement intervention. This strategy reduced prolonged AED use and potential side effects, enhancing patient care.
Area of Science:
- Neuro-oncology
- Clinical Quality Improvement
- Pharmacovigilance
Background:
- Clinical guidelines recommend short-term prophylactic antiepileptic drugs (AEDs) for seizure-naive brain tumor patients post-craniotomy (up to 1 week).
- Observed practice indicates prolonged AED use, extending up to 12 months post-surgery.
- This discrepancy necessitates a quality improvement initiative to align practice with evidence-based guidelines.
Purpose of the Study:
- To assess the impact of a multiphase intervention on adherence to prophylactic AED guidelines.
- To evaluate changes in prophylactic anticonvulsant prescription rates among newly diagnosed seizure-naive brain tumor patients.
- To improve the appropriate use of AEDs in this patient population.
Main Methods:
- A quasi-experimental, pre- and post-test intervention design was employed.
- The 16-week intervention included provider education, alerts, documentation templates, and weekly audit/feedback.
- Data were collected via chart review for adherence and prescription rates, supplemented by a provider survey.
Main Results:
- Guideline adherence significantly increased from 15.8% (pre-intervention) to 93.3% (post-intervention) (p < .01).
- Prophylactic AED prescription rates showed a non-significant decrease of 2.2% (p = .119).
- Provider knowledge regarding AED prescription likelihood and side effects showed non-significant trends towards improvement.
Conclusions:
- A combination of provider education, alerts, templates, and audit/feedback effectively improved guideline adherence for prophylactic AED use.
- Weekly audit and feedback were key components in enhancing adherence to anticonvulsant guidelines.
- The intervention demonstrates a successful strategy for optimizing AED prescribing in seizure-naive brain tumor patients.
Background And Purpose:
Clinical guidelines suggest that prophylactic antiepileptic drugs (AEDs) should be given to newly diagnosed seizure-naive brain tumor patients for up to 1 week after craniotomy. Yet, data suggest that prophylactic AEDs are used up to 12 months after surgery. A quality improvement project was implemented to improve adherence to evidence-based prophylactic AED guidelines.
Methods:
A quasi-experimental, pre- and post-test intervention design was used to assess the effect of a multiphase intervention on guideline adherence and prophylactic anticonvulsant prescription rates. The 16-week intervention consisted of provider education sessions, provider alerts, documentation templates, and a weekly audit and feedback. Participants included four providers and newly diagnosed seizure-naive brain tumor patients. Measures included guideline adherence rates and AED prescription rates extracted from chart review, and a provider attitude and knowledge survey. Analyses included descriptive statistics, Wilcoxon signed-rank tests, and Chi-square tests.
Results:
Guideline adherence increased significantly (p < .01) from 4 months before implementation (15.8%) to 1 year before implementation (27.8%) and then to 93.3% after implementation. Provider knowledge showed clinically meaningful decreases in the likelihood to prescribe prophylactic AEDs (-.5 point) and increased understanding of prophylactic AED side effects (+0.5 point), although these were not statistically significant (p = .083). Finally, prophylactic AED prescription rates decreased by 2.2% (p = .119) compared with 4 months and 1 year before implementation (2.6%; p = .072).
Conclusion:
This project highlights the important role of provider education, provider alerts, a documentation template, and audit and feedback in improving guideline adherence rate. Findings suggest that the combination intervention and weekly audit and feedback strategy can improve guideline adherence to prophylactic anticonvulsant use in seizure-naive newly diagnosed brain tumor patients.
Implications:
By following prophylactic AED guideline recommendations, clinicians can avoid the potential side effects of anticonvulsant-induced cognitive, behavioral, and psychiatric issues that can impair patients' quality of life.
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