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Optimizing Outpatient Epilepsy Care With Digital Seizure Action Plans

Optimizing Outpatient Epilepsy Care With Digital Seizure Action Plans 1024 683 Pam Georgiana

Customized seizure action plans enhance care and family use.

Many schools and caregivers require families of children with epilepsy to provide a written seizure action plan (SAP) signed by their primary care provider. The Epilepsy Foundation provides a printable PDF form to fill out, print and sign. However, the form is limited in providing space and context for individual patient needs, therapies and medications. It is not widely used with patients at Nationwide Children’s Hospital.

“We identified a low baseline in the number of patients receiving an SAP. Knowing how important it is, we felt a digital SAP and quality improvement project would be a perfect way to improve our performance,” explains Anup D, Patel, MD, neurologist at Nationwide Children’s and chief medical officer for Partners For Kids®. He is also an associate chief quality officer in the Center for Clinical Excellence at Nationwide Children’s.

The results of this quality improvement (QI) project were recently published in Pediatrics.

A multidisciplinary team, including Dr. Patel and Dara V.F. Albert, DO, MEd, child neurologist and medical director of the Psychogenic Nonepileptic Events Clinic in the Pediatric Epilepsy Center at Nationwide Children’s and an associate director of the child neurology residency program, developed a digital SAP form integrated into Nationwide Children’s electronic health record system, Epic.

The form is highly customizable for each patient. It includes easy-to-understand visuals such as a stoplight infographic (red/emergency, yellow/ask questions, and green/no intervention needed) to inform treatment decision-making.

“We consulted Nationwide Children’s Health Literacy team to ensure that the tool used reading levels, language and images that are accessible to all, including families, caregivers and health care providers,” Dr. Albert says. “We also created a Spanish-language version.”

Once completed, the form can be printed for use at home and school. It provides detailed instructions for emergencies, lists patient-specific triggers, answers common questions, and includes visuals for medications. In addition, the SAP is available in the patient’s medical record for provider use during all Nationwide visits.

The QI project initially focused on epilepsy providers and eventually expanded to all Nationwide Children’s Neurology clinics. The team used Plan-Do-Study-Act (PDSA) cycles to facilitate process changes within the clinical setting. Data were evaluated monthly using control charts.

“We learned that the biggest obstacles for implementation were a lack of general awareness of the importance of an SAP and remembering to use it,” Dr. Patel says.

Digital notifications reminded providers of the SAP, and clinical processes were standardized to include it.

The team measured the success of the QI interventions by tracking patients who received SAPs. The goal was 85% utilization. The SAP utilization rate for epilepsy providers increased from a baseline of 39% to 85% by June 2020. By February 2022, utilization was at 92% and was being maintained. The SAP utilization rate for other neurology providers increased from 43% in 2018 to 85% by July 2020. By February 2022, the rate was maintained at 93%.

“This is proof that a well-executed QI initiative can be very effective. QI takes a multidisciplinary team to embrace the initiative and commit to changes to be successful, but the results are worth it,” Dr. Albert says.

The team also asked both providers and patients for feedback on the tool’s usability and efficacy. Providers evaluated the digital version within Epic, and patients evaluated the printed SAP. Early feedback highlighted concerns about readability, aesthetics, and ease of use. In response, the team added more images and reduced the number of necessary clicks.

“Provider feedback was critical in overcoming barriers to use,” Dr. Albert explains. “This digital SAP should be a part of every neurological provider’s clinical process to limit unnecessary adverse health events and emergency department visits.”  Through the team’s efforts, the Nationwide Children’s SAP is available for all Epic users throughout the United States.

 

 

Reference:

Gumayan RL, Parker W, Gunduz MT, Aylward SC, Auer N, Alpert DVF, Patel AD. Increasing Provider Utilization of a Seizure Action Plan in the Outpatient Setting. Pediatrics. 2024;154(1):e2023061268. doi:10.1542/peds.2023-061268

Image credit: Adobe Stock

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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