To decrease the time  to get anti-epileptic medications to bedside for a patient in status epilepticus.

Status epilepticus is a medical emergency that requires urgent assessment and treatment, however recent studies have shown that it can take up to 47 minutes for the administration of the first anti-epileptic. This delay can lead to greater functional impairment and higher mortality in patient’s hospitalized with status epilepticus.

A seizure alert system (code seizure)was designed by physicians, nursing and pharmacy to expedite anti-epileptics to bedside. The alert  could be initiated by nursing staff or physicians. The code was piloted on neurology dedicated floors and was preceded by an informative lecture on seizure recognition to the nursing staff.  Once activated, the code  brought the on-call neurologist , rapid nurse, and  a pharmacy technologist with a tackle box containing Anti-Epileptic Drugs (AEDs): Levetiracetam, Phenytoin and Depakote to bedside. Lacosamide was excluded due to the controlled substance status. The tackle box also contained a dosing guideline along with instructions for mixing the medications which could be done at bedside by either the rapid nurse or the pharmacy technologist. After each code, a debrief was performed to evaluate the process. The code was then slowly expanded and adjusted to unit specifics over the entire hospital over a three-year period.

Seizure alert was  initiated 152 times (3/2021- 7/2024). Preliminary data analysis showed clear time of arrival in 47 of the 152 cases with an average time of AED arrival of 6 mins. AEDs were administered in 22 of the 47 cases with none of the patients requiring intubation or escalation of care.  

By creating a dedicated seizure alert, we have demonstrated it is possible to decrease the time it takes for anti-epileptics to arrive at the patient bedside and improve outcomes for patients who have seizures in the hospital.