LAUSR

Literature and local PICU case studies suggests high morbidity and mortality for children with prolonged seizures. A 6 month retrospective audit at a busy district general hospital in 2016 supported this and provided the basis for a regional project run jointly by paediatrics and anaesthetics. A multiprofessional prospective quality improvement project was launched regionally in December 2016, to run throughout 2017. The aim is to improve morbidity and mortality of children with prolonged seizures as measured by: Time to seizure termination Percentage intubated, ventilated or admitted to level 3 care. A secondary aim is to reduce the numbers with evidence of respiratory, haemodynamic or metabolic compromise. Data is being collected via paper and online forms. Regional resources e.g. the online PICU regional guidleines have been utilised to prompt data collection. Local teams have been recruited at 7 hospitals within the region and results fed back on a 2 monthly basis. Results have been collated regionally for time to seizure termination and time to phenytoin load. Other factors investigated are number of benzodiazepine doses given, proportion intubated and ventilated, duration of intubation and place of highest acuity of care. Over the first 9 months of the project, 134 cases have been captured regionally. Initial data collection was slow and strategies to improve this including refinement of an electronic form, local leads championing the project and local targeted strategies such as (P)s and paper lists have been successful. The first improvement is being implemented – focus on ‘thinking ahead’ to the next step of the treatment algorithm. Regionally this is planned via the PICU guidelines. Locally, run charts have been produced and local centres are considering how to best achieve this improvement. The next stages involve identifying and implementing further improvements both locally and regionally. We are hoping to utilise a nurse or allied healthcare professional via the regional paediatric network to facilitate this. For all interventions, the PDSA cycles with continuous monitoring of outcomes will be used to track effects. Where local changes lead to improvement in outcomes, we will use the regional nature of the project to enable other centres to learn and benefit from this learning.