27 Using QI methodology to increase usage of seizure action plans for pediatric patients with seizures

Background

Seizure Action Plans (SAP) have been proposed as an educational tool to help patients and caregivers be prepared for daily seizure care and emergencies. Meaningful clinical outcomes have been linked to the use of SAPs. Despite recognizing the importance of SAP use, 39% of patients seen by epilepsy providers within our outpatient epilepsy center at Nationwide Children’s Hospital received a SAP in 2016.

Objectives

Increase and sustain the percentage of outpatient epilepsy center patients with seizure rescue medications who receive SAPs, from 39% to 85%.

Methods

A multi-disciplinary QI team developed key drivers and implemented interventions, such as an imbedded clinical pharmacist in the neurology clinic to assist with SAPs, clinic nursing staff providing SAP education at discharge, SAP enhancements to ease completion within the Electronic Medical Record (EMR), utilizing clinical decision support via the EMR to remind providers to complete SAPs, and provider and nursing education (figure 1). The team created a monthly report to monitor provider compliance for creating clinically indicated SAPs. The first half of 2016 was used as the preliminary baseline data.

Results

From January 2016 to April 2021, the team increased the percentage of outpatient epilepsy center patients with an active SAP from 39% to an average of 85.6% (P<.001), resulting in a 120% improvement from baseline (figure 1).

Conclusions

Using QI methodologies, the team successfully and substantially increased provider compliance in creating clinically indicated SAPs for outpatient epilepsy center patients by 120%. Through our efforts we have been able to develop and implement a standardized and customizable SAP completed within the EMR that is now provided to nearly 90% of epilepsy center patients. This project demonstrates that high SAP utilization rates can be achieved even amongst a large, diverse group of Neurology providers. Future work linking SAP usage to decreased healthcare utilization is ongoing.