Background/context Convulsive status epilepticus (CSE) is the most common childhood medical neurological emergency, and is associated with significant morbidity and mortality.1 A retrospective one-year audit of patients admitted to a tertiary paediatric ICU from Yorkshire/Humber hospitals for CSE requiring rapid sequence induction (RSI) demonstrated that of 23 patients:
9 (40%) had delay in receiving benzodiazepine, Phenytoin and RSI respectively
5 (21%) had received excessive/inadequate benzodiazepines.
These are recognised reasons for inappropriate management of CSE.2 Yet to date no study has looked into the reasons as to why this occurs.
Methodology To perform real time A&E in-situ multidisciplinary simulation of paediatric CSE requiring RSI in Yorkshire/Humber hospitals.
By direct observation of the simulation with appropriate feedback we intend to identify/analyse:
Adherence to the local hospital protocol of the emergency management of CSE (based on NICE CG137 guidance)3
Results/outcomes To date we have completed successful simulations in two tertiary children’s hospitals, with further planned in three district hospitals.
Findings have shown a lack of adherence to protocols due to deficiencies in knowledge of the management of CSE.
Non-technical concerns included confused leadership and task overload of nursing staff, resulting in inappropriate administration of Phenytoin.
Latent risks identified include an emergency alarm in one A&E not being heard throughout the department, resulting in delay of treatment.
Potential impact By using simulation in this method we hope to accurately identify whether rescue medication is delayed or not, as per guidance. And importantly we may identify potential reasons as to why this may occur, with non-technical skills being a suspected major influence.
By ensuring the simulation is multi-centred across the region, common themes and latent risks may be identified, thus ensuring targeted strategies for improving the care of the children in Yorkshire and the Humber.
Riviello JJ, et al. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology and the practice committee of the child neurology Society. Neurology 2006;67:1542–50
Yoong M, et al. Management of convulsive status epilepticus in children. Arch Dis Child Educ Pract Ed 2009;94:1–9
NICE Guidance CG137. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care
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