Abstracts

Rationale: Folic acid supplementation is recommended for all women with epilepsy (WWE) of childbearing potential due to the increased risk of major congenital malformations associated with first trimester in utero exposure to AED and for cognitive outcomes. We sought to evaluate epileptologists compliance with documenting recommended folic acid supplementation for WWE of childbearing potential taking antiepileptic drugs (AED) on discharge from the Epilepsy Monitoring Unit (EMU) at University Hospital in Cincinnati, OH during a baseline period and following implementation of a chart reminder to increase awareness re indication for folic acid supplementation. Methods: Hospital records, including admission history and physical, discharge summary, and medication reconciliation forms were reviewed for all women discharged from University Hospital during a 12-week baseline period July September 2010 and again during a 9-week follow-up period February March 2011. In January 2011 a reminder checklist specifying whether folic acid supplementation was indicated or not was added to the EMU charts for all patients admitted to the EMU. After review of the 2009 AAN Practice Parameter and the relevant literature, our group agreed that folic acid 1mg/day or more would be the goal for this project. During review of hospital records for the baseline and follow-up periods, it was determined whether each female patient met criteria for folic acid supplementation based on child-bearing potential (age, not surgically sterile, etc.), and among those in whom folic acid was indicated, how often it was documented that a prescription for folic acid >/=1mg/d was provided at discharge. Results: During the 12-week baseline period 44 of 65 EMU admissions were female. Of those, folic acid supplementation was indicated in 12. Documentation of folic acid supplementation prescription was found in one patient (8%). During the 9-week follow-up period (after institution of chart reminder re folic acid), 33 of 50 EMU admissions were female. Of these, folic acid supplementation was indicated in 15. Documentation of folic acid prescription was found in 8 patients (53%). Thus, following institution of the chart reminder, a 45% improvement in appropriately prescribing folic acid supplementation was seen compared to baseline. Conclusions: Although the indication for folic acid supplementation among WWE of childbearing potential on AED is universally acknowledged among our epilepsy center faculty, compliance with documentation of this practice was poor. Adding a simple chart checklist reminder was followed by a 45% improvement in appropriate folic acid prescribing. Such a chart reminder is a simple, easy to implement method of improving performance on this measure. This is a measure that can be followed over time as part of a hospital quality improvement program and/or as part of a Performance in Practice (PIP) Clinical Module for Maintenance of Certification.