Abstract
Background Children with seizures who are given incorrect dosing of rescue seizure medications may have a higher risk of emergency department visits, unplanned hospitalizations and even death. As such, it is critically important that children with seizures not only receive timely treatment but also treatment with the correct dose. However, due to a fear of complications, rescue medications are frequently under-dosed (low dose). Low dose treatment is often ineffective in halting seizures.
Objectives Decrease the percentage of low dose prescriptions for rescue seizure medications placed in a Neurology clinic from 3.5% to 1.5% by December 2018 and sustain for one year.
Methods We analyzed all rescue medication prescriptions from 2013–2015. We used 2015 data to determine a baseline rate of low-dose prescriptions, while using 2013–2015 data to identify the most commonly miss-prescribed medications. We developed a Key Driver Diagram and implemented the following interventions: Midazolam pre-filled syringe program, standardized dosing, electronic chart alerts, provider education, and pharmacy reviews of each low dose.
Results The most commonly identified low-dose medication was rectal Diazepam. Our baseline rate of low-dose prescriptions using data was 3.5%. Interventions targeting efforts to eliminate low-dose prescribing resulted in a centerline shift from a baseline of 3.5% to 2.8% in January 2016. There was a second centerline shift to 1.59% in September 2017.
