Authors (including presenting author) :
C Chan(1), TN Shum (1), M Lau (1), NL Yip (1), CH Chu(1), L Chan (2), S Ip (3) H Leung (1)
Affiliation :
(1) Department of medicine and therapeutics, Prince of Wales Hospital
(2) Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
(3) Department of Medicine, North District Hospital
Introduction :
Specialist nursing in epilepsy is an initiative supported by Annual Plan Program of NTEC. The program was previously piloted by Chinese University of Hong Kong(CUHK) and it was formally started in 10/2021. We reported its clinical utility in the first 12 months.
Objectives :
The specialist nursing service consists of an in-patient and an out-patient service. The objectives as approved by the Annual Plan Program were to provide early supported discharge to epilepsy patients, having regard to refractory epilepsy and subgroup of epilepsy patients to enhance the qualitative aspect of clinical care.
Methodology :
The in-patient part has a structured ward screening using 9 designated keywords* to aid clinicians in the triage of patients with seizures and epilepsy. Early supported discharge was performed as part of the screening program. The outpatient service consists of an “epilepsy clinic” within the milieu of a busy neurology outpatient setting. A high-risk epilepsy clinic is run alongside the electrodiagnostic unit(EDU), which caters for patients with early discharge, supplemented by phone follow-ups. Carer training of intranasal(I.N.) midazolam in selected cases and additional EEGs (electroencephalogram) were performed for both standard and video EEGs. This serves as a top-up plan for refractory epilepsy patients in whom presurgical evaluation is required, and where the epilepsy nurse may function as a “case-manager”. The clinical effectiveness of specialist nursing in epilepsy was assessed in terms of volume of service delivery and metrics (quantitative) and benefits conferring on subgroup of patients (qualitative).
Result & Outcome :
Tentative data in the first 12 months showed a ward screening volume of 1253 cases albeit the COVID-19 pandemic. The “epilepsy clinic” milieu served 949 patients. The high-risk epilepsy clinic has catered for 285 patients with an additional 367 patients receiving tele-medicine service. Top-up standard EEGs were performed in 436 patient-episodes and video EEGs performed in 21 patients, forming a close partnership with EDU. A full 12 months of the combined epilepsy surgery clinic served the role of a “case-manager”. Carer training sessions provided 2 hostels and 2 additional families via telemedicine with the proper teaching and training on I.N. midazolam usage.
In qualitative terms, the subgroup of epilepsy patients served by this program included (1) patients with drug compliance issues needing rectification, (2) patients developing serious side effects after commencement of antiseizure medications eg allergic reactions, liver derangement, etc (3) patients proactively given information about COVID-19 vaccination or patients who raised issues regarding exemption certificates, (4) patients with tuberous sclerosis who required mTOR inhibitors and serum everolimus level checking, (5) patients followed up by paediatric colleagues beyond 18 years of age attaining transitional care, (6) patients requiring counseling on driving, pregnancy and occupational issues (7) patients with psychotropic drug abuse, either known or discovered by team. Patient empowerment was provided through the use of seizure diaries. A full 12-month of Friday pm teaching sessions fostered collaboration among epileptologists in NTEC.
Specialist nursing in epilepsy provided a crucial aspect of clinical care in neurology aiding doctors in the day-to-day running of acute in-patient care, helping with early discharge through a supported program. In addition, epilepsy nurses conferred a qualitative aspect to the care of patients which doctors alone may not be able to deliver, including but not limited to refractory epilepsy, COVID-19 issues and drug-related issues.
*The keywords are epilepsy, seizure, GTCS, Grand-mal, convulsions, status epilepticus, loss of consciousness and blackout.
