G434(P) Prescribing practices for buccal midazolam and its use in the community

Abstract

Background NICE Clinical Guideline 137 recommends prescribing buccal midazolam to children who have prolonged (lasting 5 min or more) or repeated (3 or more in an hour) convulsive seizures in the community. Treatment should be administered by trained clinical personnel or, if specified by an individually agreed protocol drawn up with the specialist, by family members or carers with appropriate training. Aims We aimed to audit Buccal Midazolam prescriptions and to review if: 1)Prescribers are following the NICE guideline. 2)Correct dose (according to BNF) is prescribed. 3)These are part of the written epilepsy plan. Methods 24 children registered with General Practioners and who had buccal midazolam on their repeat prescription records were identified. Results Of the 24 children included in the study, 12 were in mainstream school and 12 were in special needs school. 15 children were on antiepileptic drugs.10 children had generalised tonic–clonic seizures with or without absences, 7 had focal or multifocal seizures plus generalised tonic–clonic seizures (secondary generalised), 4 had focal seizures, 2 had multifocal seizures, and 1 child had absence seizures occurring in clusters. 1 child had focal seizures lasting less than 5 min (but was prescribed buccal midazolam due to parental anxiety). 23 children had seizures lasting more than 5 min.22 children were under the care of a hospital consultant. 2 children had been discharged and GPs were asked to stop midazolam; but continued to be on repeat prescriptions. 21 children were on the appropriate dose according to BNF. 23 children had reference to a written management plan with 19 having a copy in the notes. 17 children had documented evidence of training delivered to parents. 19 children had an emergency plan at school. 10 children had used buccal midazolam in the community. Conclusion Majority of the prescriptions were in accordance with the NICE guidelines and on the appropriate dose. All but 1 had a written management plan but only 19 were available in notes. The fact that 2 children were still on the list of repeat prescription by the GP even after discharge was worrying and would not have come to attention if it was not for the audit.