AUSTIN, Texas — After designing a team-care strategy for parents and hospitals to follow, kids with epilepsy missed fewer doses of daily anticonvulsant medication on days they had to make trips to the hospital, researchers reported here.
Prior to application of the improvement strategies, only 76% of kids received anticonvulsant doses at home and 23% received them while at the hospital, but after implementation, 90% of kids were receiving their doses at home (95% CI 86%-93%, P<0.01) and 92% were getting them in the hospital (95% CI 65%-100%,P<0.001), according to Charlotte T. Jones, MD, PhD, of Nationwide Children’s Hospital in Columbus, Ohio, and colleagues.
“We found that one in four kids weren’t getting their seizure medicines. So we did a quality improvement project to get kids their medicine, not only because it reduced seizures in the hospital, but because it says to parents — not only do we think that you should be doing it, but we’re going to model that it’s important,” Jones told MedPage Today at the Child Neurology Society annual meeting.
“The one thing that we ask of parents is that they give their kids the seizure medication, but how can we say ‘You’re noncompliant’ when the hospital does worse than the parents?”
At [baseline], one in four kids were being admitted to the floor or sent home without having gotten it [anticonvulsant medication]. Since April, every single kid has either gotten it at home or gotten it before their procedure,” Jones added.
Jones and colleagues developed the Institute for Healthcare Improvement methodology to integrate better adherence to anticonvulsant dosing in kids with epilepsy. The new strategy is based on standardized guidelines for parents, and boosting communication between anesthesiologists, neurologists, pharmacists, and nurses to administer scheduled doses during the home-to-hospital transition.
- Getting pre-anesthesia nurses to double-check with the parents about their plan to administer anticonvulsants
- Standardizing hospital guidelines for administering anticonvulsants when kids are on NPO (no food by mouth) for parents to follow
- Standardizing guidelines for parents to follow for giving the medication when pre-anesthesia, cardiology, and MRI activity are in play
- Promoting communication through team meetings to boost awareness of errors in care and the consequences of negative outcomes from missed doses
- Encouraging the teams to try to schedule MRI scans later in the day to prevent missed morning doses
- Designing a substitution table for anticonvulsants in the event that IV, dissolving, or crushable formulations are necessary
“You’ve got to team up with your anesthesiologist, because you may say, ‘I see this outcome,’ but they’re the people that own the process. You can be a cheerleader and you can point out when things don’t go well, but you have to convince them that it matters. Sometimes we work together to do what’s right for the kids, not only at that moment, but to model at your institution that kids getting their seizure medicines is worth the extra effort. What parents see us doing is what they leave doing themselves,” Jones told MedPage Today.