F19. Standardized perioperative care for epilepsy surgery patients

Abstract

Approximately 45 patients a year undergo epilepsy surgery at Children’s National Medical Center. We initiated an individualized perioperative plan for epilepsy surgery patients 8 years ago in order to standardize management. Goals of the standardized perioperative care plan were to minimize medication errors, improve communication across teams and streamline care for efficiency and the patient experience. In 2009, we identified patients undergoing epilepsy surgery were at high risk for medication errors. We set out to devise a perioperative seizure plan that would improve safety for patients in this vulnerable time period. Opportunities for standardization included assignment of loading doses to specific teams (e.g. intraoperative Dilantin), documentation of current seizure medications, including dosing, formulation and schedule, documentation of historical intolerances of medication and a seizure rescue plan. The perioperative care plan has been in use for 8 years. All epilepsy surgery patients are cared for according to an individualized perioperative plan created by a multidisciplinary team prior to surgery. Implementation is shared by members of the care team including epilepsy, neurocritical care, anesthesia, neurosurgery and nursing. This plan is relied upon and recent modifications have broadened the scope to also include standardization of postoperative imaging. Perioperative seizure management can be standardized to minimize medication errors, improve communication and streamline care across multiple care teams and locations.