Natalie Klein
Virginia Commonwealth University Health System
Richmond, VA
Disclosure information not submitted.
Lisa Kurczewski, PharmD, BCCCP
Pharmacist
Virginia Commonwealth University Health System, United States
Disclosure information not submitted.
Title: Evaluation of Inpatient Stat Antiepileptic Drug Administration Delays
Introduction: In prolonged seizing patients, the treatment goal is to quickly terminate clinical and electrographic seizure activity with prompt antiepileptic drug (AED) administration. At our institution, AEDs ordered as “stat” or “now” doses should be administered within 60 minutes (min). This study evaluates AED administration and potential barriers to prompt care in patients who received a “stat” AED order after 60 min.
Methods: This retrospective study evaluated patients who had one-time, “stat” or “now” orders for the following AEDs: fosphenytoin, lacosamide, levetiracetam, phenobarbital, and valproic acid from January 2019 to June 2021. Patients were stratified based on time from order entry to nurse charting into two groups: 0 to 59 min and 1 to 4 hours (hr). Data collection performed by chart review included: time course from order placement, order verification and administration charting, patient location (emergency department, intensive care unit, floor), product type (premixture or admixture), medication requests by nursing, late chart reason documented by nursing, and progression to refractory seizures identified by AED continuous infusions.
Results: Of the 2382 patients, 1773 patients were in the 0-59 min group and 609 were in the 1-4 hr group. Median time from order entry to verification (in min) was 5.5 and 9.1, respectively. The median time from order verification to administration was 17.75 in the 0-59 min group and 72.69 in the 1-4 hr group. For both groups, the most common AED ordered was levetiracetam premix product with a median order to chart time of 22 and 86.82, respectively. The AED with the longest duration from order to charting was phenobarbital with a time of 92.5. Floor patients experienced longer order to charting times in both groups with medians of 32 and 87.5, respectively. To analyze charting delays, 154 patients with medication requests were evaluated. The most common reason for delay was related to pharmacy (72%). Seven patients with delays had refractory seizures. Of these patients, six delays were with admixture products with 71% of delayed reasons relating to pharmacy.
Conclusion: Our findings add to the literature describing timeliness of AED administration in clinical practice and support the use of premix products whenever possible to avoid medication preparation delays.