Abstract Details

Title Assessment of Time of Administration from Time of Order of Anti-Epileptic Drugs in Status Epilepticus

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S48 - (-)

Poster/Presentation
Number 007

Objective

Background Prolonged SE can lead to neuronal damage and loss. Animal models have shown that extent of neuronal injury is associated with seizure duration. Mortality rate and systemic complications worsen with duration of SE. Ultimately, delay in treatment contributes to refractory SE and adverse outcome for the patient.

Design/Methods In this retrospective study, cases of SE were identified from the adult neurology census in May 2012 at the University of Kentucky. Administration time of AED load doses was assessed. Maintenance medications and patients with seizures resolved on presentation were excluded. Time to administration was calculated from the time the order was placed by the physician to the time the patient received the medication.

Results Twenty five patients with SE were identified. Average AED administration time was 71 minutes (SD 59). Orders placed as routine (3) were administered on average in 98 minutes (SD 91) and STAT orders (22) in 66 minutes (SD 57). Orders placed by a non-neurologist (4) averaged 55 minutes (SD 31) whereas orders placed by neurology (21) averaged 74 minutes (SD 64).

Conclusions AED administration was more delayed than would be desired. Great variability exists in the time to AED loading dose administration. Delays in AED administration occur at three levels of care: the physician (STAT verses routine orders), pharmacy (order review, preparation and delivery), and nursing (drug administration). Delays in nursing may occur due to failure in communication with nurses, lack of sense of urgency, and availability to administer the medication. Following these findings an electronic status order set has been created with default STAT medication settings. Formal education of nurses and physicians has been instituted with a pre- and post-test.

Authors/Disclosures
Alexandra C. Boske, MD PRESENTER	Dr. Boske has nothing to disclose.
	No disclosure on file
Meriem K. Bensalem Owen, MD (University of Kentucky)	Dr. Bensalem Owen has received personal compensation in the range of $0-$499 for serving as a Principle Investigator (PI) with Xenon. Dr. Bensalem Owen has received personal compensation in the range of $0-$499 for serving as a PI with UCB. Dr. Bensalem Owen has received personal compensation in the range of $0-$499 for serving as a PI with NeuroPace.
Kenneth L. Marek, MD (IND)	Dr. Marek has received personal compensation for serving as an employee of IND. Dr. Marek has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for invicro. Dr. Marek has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Marek has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Marek has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biohaven. Dr. Marek has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for takeda. Dr. Marek has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Denali. Dr. Marek has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Koneksa. Dr. Marek has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Xingimaging. Dr. Marek has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuron23. Dr. Marek has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lilly. Dr. Marek has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven. Dr. Marek has received research support from Michael J Fox Foundation.

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