• Primary objective is to reinforce standard of care protocol for breakthrough seizure in our hospital by incorporating an EPIC order set outlining initial tests needed. Secondary objective is to identify gender-based and racial disparities.

We observed guidelines for the management of breakthrough seizures were not followed appropriately in our hospital, leading to inadequate management of seizures, polypharmacy and increased morbidity. The creation of a standard order set within EPIC system may assist clinicians identify the etiology of the seizure and prevent medical errors.

The mean presenting age was 58 with most of our patients being white (44%), African American (26%), and Hispanic (11%). About 55% (N=6) of females, ages 18-50, were not administered a pregnancy test. Patients did not get a UDP (50%) or alcohol screening (56%) on presentation. Patients with prior history of epilepsy, did not get ASM levels checked (N=15) and only one of them received their home rescue medication. Neuroimaging was obtained only in 8.5% (N=6).  

Evidence-based guidelines provide a reference for optimal standard of care. Consistently following guidelines is imperative for treatment of patients with seizures. A standard order set will alert physicians to obtain labs and images in an organized and simple manner, preventing mistakes, avoid missing critical information to the patient's initial presentation and eventually reducing re- hospitalizations to an already overloaded healthcare system.