GME Patient Safety Quality and Innovation Symposium

Issues addressed and background:

The landscape of pediatric epilepsy is rife with difficult medication decisions in a vulnerable patient population.  The decision of which antiseizure medications to use, dosage, the side effect counseling, and the idiosyncrasies of each medication can be overwhelming.  The barriers to prescribing these medications are even higher to new child neurology trainees with little experience prescribing seizure medications, as well as rotating adult neurology colleagues who do not typically have to consider weight-based dosing and pediatric-specific considerations.  The antiseizure medication handbook aims to improve trainees’ comfort on overnight call, decrease medication dosing errors, and improve identification and counseling of medication side effects by providing vetted weight-based dosing and clinical pearls for each medication.  Outcome measures will be obtained by end-user post-survey data on self-assessed efficiency on call, comfort answering seizure medication-related questions, and comfort prescribing new seizure medications.  Process measures will include handbook utilization rates and utilization circumstances.  Balancing measures will include assessment of any reported medication dosing errors or incorrect counseling, or medication side effects identified on admitted patients or patients seen at follow up visits.

Description of the project, protocol, experience, service, or innovation:

A comprehensive list of antiseizure medications was compiled and a team of multiple child neurology residents and child neurology faculty compiled key medication information from evidence-based resources (Lexicomp, FDA labels, etc…).  Ishikawa diagrams/surveys were used to determine greatest barriers for first call providers in initiating and counseling for these medications. This team performed an extensive review of each medication, highlighting clinical pearls when initiating the medication, counseling, dosing/discontinuing, or monitoring for side effects to address identified barriers.  This handbook was further reviewed by the pediatric epileptology faculty for verification and agreement.  The handbook was deployed to all trainees in the child neurology department on March 15, 2023, as well as rotating adult neurology residents.  The team plans to assess by surveys utilization of the handbook, usefulness and efficiency, and assess balancing measures of reported medication dosing errors. 

Lessons learned and expected outcomes:

Though feedback is still ongoing, early responses suggest trainees have found this handbook useful in multiple clinical settings.  Though initially targeting periods in which trainees were on overnight, the benefits of this handbook have extended to several clinical contexts.