title: Optimizing anticonvulsant administration for children before anesthesia: a quality improvement project.
abstract: OBJECTIVE
  Children with epilepsy are at increased risk of missing scheduled anticonvulsants during the home-to-hospital transition, including when being admitted for procedures requiring anesthesia. This may contribute to breakthrough seizures because of lowered anticonvulsant levels. We conducted an interdisciplinary quality improvement project with a specific aim to increase the percentage of children receiving their anticonvulsants as scheduled before procedures requiring anesthesia.
  
  
  METHODS
  The Institute for Health Care Improvement methodology was used to develop an interdisciplinary team and improve the process of ensuring administration of maintenance anticonvulsants. Successful components of the improvement project included focusing on the outcome for patients, standardization of medication administration when "nothing per os" before anesthesia and development of a contingency plan when children had not received anticonvulsants at home.
  
  
  RESULTS
  The percentage of children receiving their anticonvulsants medications at home before procedures requiring anesthesia increased from 58 of 76 (76%) to 334 of 370 (90%) (P = 0.002). The number of children receiving maintenance anticonvulsant medications in the hospital before the procedure increased from 8 of 38 (21%) to 15 of 16 (91%) (P < 0.001).
  
  
  CONCLUSIONS
  The use of established quality improvement methods improved the number of children receiving maintenance anticonvulsants during the home-to-hospital transition. The transition into the hospital for children with chronic illnesses includes a handoff between parents and medical staff. Future efforts to improve care during the home-to-hospital transition will require sustaining these gains and the involvement of parents.
authors.affiliation: Division of Child Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: charlotte.jones@nationwidechildrens.org.
authors.forename: Charlotte T
authors.initials: CT
authors.lastname: Jones
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Vidya T
authors.initials: VT
authors.lastname: Raman
authors.affiliation: Department of Neurology, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Seth
authors.initials: S
authors.lastname: DeVries
authors.affiliation: Department of Pharmacy, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Cole
authors.affiliation: Center for Innovation in Pediatric Practice, Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Kelleher
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000293:Adolescent; D000758:Anesthesia; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010290:Parents / Q000523:psychology; D058996:Quality Improvement
chemical_list: D000927:Anticonvulsants
keywords: anticonvulsants; epilepsy; hospital care; neurological disorders; pediatric; quality improvement; transitions