Improving the Management of Prolonged Seizures in Wessex QI Project Interim Report, January 2017
Background It is known, anecdotally and from other audits, that there is high morbidity and mortality for children with prolonged seizures. Contributors to morbidity include respiratory and/or cardiovascular compromise due to ongoing seizure activity. Any mortality, if due to failure to terminate a seizure in a hospital setting is unacceptable.
Project Aims (what are we trying to accomplish) A reduction in morbidity & mortality from prolonged seizures.
Initial questions to investigate are:
Time taken to seizure termination
Number of patients with seizures who have evidence of respiratory compromise (need for airway manoeuvres, BVM, respiratory acidosis, oxygen requirement)
Number of patients with seizures who have evidence of cardiovascular compromise (raised lactate)
Aim is to investigate these questions regionally and identify any possible improvements in processes or learning points from particular sites which can then be disseminated across the region.
Brief description including setting (e.g. ward based, community etc) Regional project – including all children presenting to hospital (assessment units, ED, ward, PICU) with a generalised tonic clonic seizure > 5 minutes duration even if this has terminated by the time of assessment.
Data will be collected by local team and sent to project leads who will collate and disseminate back to region to maximise learning.
How will we know a change is an improvement? (what are your measures?) Continual monitoring of project questions and observing if interventions lead to reduction in time to seizure termination and/or improvements in numbers of patients with or degree of respiratory or cardiovascular compromise.
Identification of potential interventions to improve process and/or outcomes
Next steps Continue data collection and raising awareness of the project around the region. Begin disseminating results on a monthly basis and as interventions are identified, introducing these and tracking changes.
Project lead, role and contact details
Project leads: Neeraj Bhangu (paediatrics) & Olivia Shields (anaesthetics) There is a lead consultant and trainee at each site.