PDF(Pubmed)
Abstract：
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.
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.
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%.
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.
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.
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%.
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.
摘要：
目的：非惊厥性癫痫持续状态（NCSE）的延迟治疗可导致发病率和死亡率增加。我们先前确定，我们机构对NCSE的低效治疗源于紧急抗癫痫药物（ASM）的延迟启动。在本研究中,我们评估了这些时间参数的轨迹,并确定了特定质量改进(QI)干预措施后的患者结局.
方法：QI干预措施，在2019年1月至2021年9月期间,一个专门的多学科工作组实施了包括修订学员教育内容和药房工作流程优化.在昏迷和非昏迷患者中评估了NCSE患者启动和施用ASM所需的时间以及患者死亡率，并与干预前的相应值进行了比较。
结果：74例患者发生NCSE79例。从脑电图上的癫痫发作检测到NCSE的第一次和第二次ASM的中位数时间减少了4（p=0.83）和8分钟（p=0.52），分别与开始干预之前的时间进行比较。所有NCSE发生的从顺序到第一次和第三次ASM的中位时间减少了8和10分钟，分别为(p=0.28和p=0.10)。在目前的昏迷患者队列中，与我们之前的研究相比,首次订购ASM的中位时间减少了16.5min,给药时间减少了35min.患者总死亡率降低了11.1%。
结论：多学科团队的努力旨在简化药房的运作，加强学员和护士的教育，可以更有效地在NCSE患者中提供抢救ASM并改善其死亡率。
方法：QI干预措施，在2019年1月至2021年9月期间,一个专门的多学科工作组实施了包括修订学员教育内容和药房工作流程优化.在昏迷和非昏迷患者中评估了NCSE患者启动和施用ASM所需的时间以及患者死亡率，并与干预前的相应值进行了比较。
结果：74例患者发生NCSE79例。从脑电图上的癫痫发作检测到NCSE的第一次和第二次ASM的中位数时间减少了4（p=0.83）和8分钟（p=0.52），分别与开始干预之前的时间进行比较。所有NCSE发生的从顺序到第一次和第三次ASM的中位时间减少了8和10分钟，分别为(p=0.28和p=0.10)。在目前的昏迷患者队列中，与我们之前的研究相比,首次订购ASM的中位时间减少了16.5min,给药时间减少了35min.患者总死亡率降低了11.1%。
结论：多学科团队的努力旨在简化药房的运作，加强学员和护士的教育，可以更有效地在NCSE患者中提供抢救ASM并改善其死亡率。
