Abstracts

Rationale: We have previously shown that the delivery of the first, second and third order medications for nonconvulsive status epilepticus (NCSE) was delayed at the University of Nebraska Medical Center (UNMC), a level 4 epilepsy center. We established that the delay in medication delivery was caused by untimely recognition of seizures and prolonged medication order processing. To overcome the latter barrier and streamline the completion of medication orders, we examined the points of specific delays within the inpatient pharmacy. We also engaged pharmacy managers to provide staff education and support the placement of commonly used anticonvulsants in the Omnicell medication dispensing system on the hospital floors. Methods: We provided the education to the pharmacy and nursing staff following the implementation of the Omnicell medication dispensing system for the use of intravenous levetiracetam (LEV) and lacosamide (LCM) on the neurology floor in 2018. The retrospective chart analysis was performed to compare the times from the order to administration of all anticonvulsants following the implementation of Omnicell system with the corresponding times during the preceding 3-year period for all patients with NCSE; the anesthetic medications were excluded. Results: A total of 77 and 38 orders for the first, second, and third order anticonvulsants for NCSE were placed prior to and following the implementation of floor-based dispensing system, respectively. Of them, intravenous LEV and LCM were ordered in 24 (31.2%) and 14 (36.8%) of instances prior to and after the improvement, respectively; the proportions of these orders were similar in two groups (p=0.54; Pearson’s chi-squared test). The median latencies to the administration of all anticonvulsants prior and following the implementation of the Omnicell system were 34 (IQR 18-58) and 21 min (IQR 12-45), respectively (p=0.18, Mann-Whitney test). The median time to the administration of LEV and LCM have decreased from 57 (IQR 41-99) to 42 min (IQR 31-105) after the introduction of the Omnicell dispensing system and staff education (p=0.41; Mann-Whitney test). Conclusions: The delivery of treatment for NCSE may be streamlined by the education of pharmacy staff and closer proximity of the medications commonly used in acute seizure emergencies to the patients’ bedside. Funding: Dr. Taraschenko received research support from Frances E. Lageschulte and Evelyn B. Weese New Frontiers in Medical Research Fund.