Seizure Action Plans for Pediatric Patients With Epilepsy: A Randomized Controlled Trial.

OBJECTIVES: Seizure action plans help patients and caregivers better self-manage their epilepsy. We hypothesized that providing pediatric patients and their caregivers with a seizure action plan would reduce unplanned health care utilization and decrease the impact of epilepsy. METHODS: We developed a seizure action plan for use in pediatric epilepsy patients. A prospective cohort was randomly assigned to receive a seizure action plan in addition to standard epilepsy care or to standard epilepsy care alone. All caregivers were surveyed using the Modified Impact on Families (MIF) questionnaire at enrollment, 3 months, and 12 months. Health care utilization measures and Modified Impact on Families questionnaire scores were compared between the 2 groups. RESULTS: Fifty-four patients received a seizure action plan and standard care, whereas 48 received standard care alone. The groups had similar demographics. There was a significantly higher proportion of overall clinic appointment no shows in the standard care group vs the seizure action plan group (P = .04); however, other significant differences in health care utilization were not found. Among patients with low seizure frequency (12 or fewer seizures per year), Seizure comfort scores on the Modified Impact on Families questionnaire were significantly higher at 12 months among the seizure action plan group compared to the standard care group. SIGNIFICANCE: Caregivers for patients with epilepsy receiving a seizure action plan were more comfortable regarding seizure care and missed fewer appointments. However, differences in health care utilization were not present. The seizure action plan appears to have more impact in patients who experience lower seizure frequencies. Further studies evaluating the impact as well as assessing caregivers' perceptions of the seizure action plan using a larger sample are needed.

Nursing satisfaction with implementation of electronic medication administration record.

Nurses' perceptions of electronic medication administration record documentation versus medication administration record documentation over time in workload, teamwork, ease of documentation, drug information accuracy, patient safety, and overall satisfaction are not well understood. Using survey methods and a longitudinal design, nurses administering medications completed the Nursing Satisfaction with eMAR instrument anonymously after electronic medication administration record implementation and at 3 and 6 months. Data were analyzed using comparative and correlational statistics, and analysis-of-variance models used to complete multivariable regression. Participants were 719 nurses: baseline, n = 389; 3 months, n = 213; and 6 months, n = 117. Electronic medication administration record documentation was associated with perceived improvement in overall nurse satisfaction, workload, teamwork, ease of documentation, drug information accuracy, and patient safety across time periods (all P < .001) and in trends across time, (all P < .001). After regression, electronic medication administration record satisfaction improved across time periods (all P < .02), with the greatest improvement between baseline and 6-month follow-up (P < .001). An electronic medication administration record documentation system is associated with overall nurse satisfaction and perceptions of improvement in workload, teamwork, ease of documentation, drug information accuracy, and patient safety but not nurse/pharmacy communication. Since timeliness and accuracy of nurse/pharmacy communication remain key components to safe and timely medication administration and documentation, nurse and pharmacy personnel should develop alternate systems of communication.