PMID- 36640479
OWN - NLM
STAT- MEDLINE
DCOM- 20230222
LR  - 20240202
IS  - 1872-6844 (Electronic)
IS  - 0920-1211 (Print)
IS  - 0920-1211 (Linking)
VI  - 190
DP  - 2023 Feb
TI  - Reducing seizure to needle times in nonconvulsive status epilepticus with 
      multifaceted quality improvement initiatives.
PG  - 107085
LID - S0920-1211(23)00010-4 [pii]
LID - 10.1016/j.eplepsyres.2023.107085 [doi]
AB  - OBJECTIVES: Delayed management of nonconvulsive status epilepticus (NCSE) can 
      lead to an increased morbidity and mortality. We previously established that 
      inefficient treatment of NCSE at our institution stemmed from delayed initiation 
      of emergent anti-seizure medications (ASM). In the present study, we assessed the 
      trajectories of these time parameters and determined patient outcomes following 
      the specific quality improvement (QI) interventions. METHODS: The QI 
      interventions, including the revision of the educational content for trainees and 
      pharmacy workflow optimization were implemented between January 2019 and 
      September 2021 by a dedicated multidisciplinary task force. The times needed to 
      initiate and administer the ASMs for patients with NCSE as well as patient 
      mortality were assessed in comatose and noncomatose patients and compared with 
      the corresponding values prior to the interventions. RESULTS: There were 79 
      occurrences of NCSE in 74 patients. The median time from seizure detection on EEG 
      to the order of the first and second ASM for NCSE was reduced by 4 (p = 0.83) and 
      8 min (p = 0.52), respectively compared to the times prior to the initiation of 
      interventions. The median times from the order to administration of the first and 
      third ASM for all NCSE occurrences were reduced by 8 and 10 min, respectively 
      (p = 0.28 and p = 0.10). In the present cohort of comatose patients, the median 
      time spent to order the first ASM was reduced by 16.5 min and the time to 
      administer it reduced by 35 min compared to that in our previous study. The 
      overall patient mortality was decreased by 11.1%. SIGNIFICANCE: More efficient 
      delivery of rescue ASMs in patients with NCSE and improvement in their mortality 
      can be achieved with multidisciplinary team efforts aimed at streamlining the 
      functioning of pharmacy and strengthening the education of trainees and nurses.
CI  - Copyright (c) 2023 Elsevier B.V. All rights reserved.
FAU - Gupta, Navnika
AU  - Gupta N
AD  - Department of Neurological Sciences, University of Nebraska Medical Center, 
      Omaha, NE, USA.
FAU - Baang, Hae Y
AU  - Baang HY
AD  - Department of Neurological Sciences, University of Nebraska Medical Center, 
      Omaha, NE, USA.
FAU - Barrett, Wattana
AU  - Barrett W
AD  - Department of Neurological Sciences, University of Nebraska Medical Center, 
      Omaha, NE, USA.
FAU - Reisbig, Katharine
AU  - Reisbig K
AD  - Acute Care Pharmacy, Nebraska Medicine Hospital, Omaha, NE, USA.
FAU - Bendlin, Kayli A
AU  - Bendlin KA
AD  - Acute Care Pharmacy, Nebraska Medicine Hospital, Omaha, NE, USA.
FAU - Coleman, Scott A
AU  - Coleman SA
AD  - Acute Care Pharmacy, Nebraska Medicine Hospital, Omaha, NE, USA.
FAU - Samson, Kaeli
AU  - Samson K
AD  - Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, 
      USA.
FAU - Taraschenko, Olga
AU  - Taraschenko O
AD  - Department of Neurological Sciences, University of Nebraska Medical Center, 
      Omaha, NE, USA. Electronic address: olha.taraschenko@unmc.edu.
LA  - eng
GR  - P20 GM130447/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20230111
PL  - Netherlands
TA  - Epilepsy Res
JT  - Epilepsy research
JID - 8703089
SB  - IM
MH  - Humans
MH  - *Coma/diagnosis
MH  - Quality Improvement
MH  - Electroencephalography
MH  - *Status Epilepticus/diagnosis
MH  - Cognition
PMC - PMC9979156
MID - NIHMS1865142
OTO - NOTNLM
OT  - Anti-seizure medications
OT  - Medication delivery
OT  - Medication order set
OT  - Quality improvement
OT  - Resident education
OT  - Status epilepticus
COIS- Disclosure of Conflict of Interest O.T. received salary and research support from 
      the NIH P20GM130447 Cognitive NeuroScience and Development of Aging (CONDA) 
      Award. All other authors report no disclosures. We confirm that we have read the 
      journal's position on issues involved in ethical publication and affirm that this 
      report is consistent with those guidelines.
EDAT- 2023/01/15 06:00
MHDA- 2023/02/22 06:00
PMCR- 2024/02/01
CRDT- 2023/01/14 18:05
PHST- 2022/07/27 00:00 [received]
PHST- 2023/01/05 00:00 [revised]
PHST- 2023/01/09 00:00 [accepted]
PHST- 2023/01/15 06:00 [pubmed]
PHST- 2023/02/22 06:00 [medline]
PHST- 2023/01/14 18:05 [entrez]
PHST- 2024/02/01 00:00 [pmc-release]
AID - S0920-1211(23)00010-4 [pii]
AID - 10.1016/j.eplepsyres.2023.107085 [doi]
PST - ppublish
SO  - Epilepsy Res. 2023 Feb;190:107085. doi: 10.1016/j.eplepsyres.2023.107085. Epub 
      2023 Jan 11.