IS THE CURRENT MANAGEMENT OF STATUS EPILEPTICUS IN CHILDREN SAFE AND USER FRIENDLY? A SURVEY OF HEALTHCARE PROFESSIONALS Litherland, C.E; Principal investigator, Mulla, H; Co-Director, Centre for Therapeutic Evaluation of Drugs in Children, University Hospitals Leicester, UK

The survey was funded by Therakind Ltd

Objectives: _ To establish the current approach to management of Status Epilepticus in children _ Collate the experiences of healthcare professionals providing this treatment _ Evaluation of the suggested improvements to the current buccal midazolam preparation to improve safety and user friendliness

Method: The survey was in the form of a short semi- structured interview, conducted face to face or over the phone. Participants were selected from centres from the East of England to Yorkshire, and included specialist clinicians, specialist nurses, community paediatricians, pharmacists, A&E staff and staff from specialist schools. The interviews took place over a six week period between August and September 2009. The data were collated anonymously, and data analysis was in the form of summary statistics and descriptive analyses.

Results: The survey spanned 12 main centres and their associated community staff and included city and rural areas. Out of a total of 63 professionals approached, 50 interviews (33 face to face, 17 by telephone) were completed. This provided a good cross section of staff experience, and some rich descriptive data around the use of different preparations. Initial analyses show that the first line treatment for inpatients in 8/12 (67%) is lorazepam IV, diazepam PR or buccal midazolam; 2/12 (17%) centres use lorazepam IV or diazepam PR as first line options. Two centres use buccal midazolam only as their first line choice for both inpatient and patients in the community, with lorazepam or midazolam IV as rescues if ineffective. All centres (100%) offer patients buccal midazolam in the community; 42 % (5/12) of these centres use both diazepam PR and buccal midazolam. Standard doses were given in 2/10 (20%) of the centres, rather than individualised doses. Knowledge of whether different formulations and routes in use were licensed was variable, with several staff stating that they did not know, and others incorrectly assuming that preparations were licensed. All centres are using multi-dose formulations of buccal midazolam. The importance of providing education in order to ensure safe and effective treatment in a timely way was highlighted throughout the survey. The most popular suggested improvement for buccal midazolam preparations was a pre-filled syringe followed closely by the availability of a licensed formulation and changes to regulations to enable paramedics to administer buccal midazolam.

Conclusion: There appears to be wide acceptance of the buccal midazolam preparation as a safe and effective treatment for Status Epilepticus despite it not being licensed for the indication or route. The development of a pre-filled, single dose syringe was regarded as a positive improvement, having benefits for both the user and patient, ensuring that the correct dose is given and that treatment is administered quickly. This should not diminish however, the wide education required for families, carers and the multidisciplinary team.