Guidelines, training, audit, and quality standards in children's epilepsy services: Closing the loop

Kirkpatrick, Martin; Dunkley, Colin; Ferrie, Colin D.; Flower, Diane; Waldron, B. A.; Whitehouse, William P; Cross, J. Helen; Rodie, Philippa; Appleton, Richard

doi:10.1016/j.seizure.2014.07.009

Cited by 7 publications

(9 citation statements)

References 15 publications

(13 reference statements)

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“…This review is the first UK-wide review of children's epilepsy deaths since the 2002 National Sentinel Audit [3] and follows considerable national initiatives to improve the quality of care for children with epilepsies, including the publication of national guidelines for epilepsy care [4][5][6][7]. As a nationally commissioned review, we were able to ensure full coverage from all four devolved nations of the UK.…”

Section: Discussionmentioning

confidence: 99%

“…13/33 (39%) 4 Was there evidence that aetiology was considered in establishing the diagnosis? 23/33 (70%) 5 Was there evidence that co-morbidities were considered in establishing the diagnosis?…”

Section: Issue Case Assessors' Examples From the Case Reviewmentioning

confidence: 99%

“…This was particularly related to limited access to specialist paediatric neurology expertise and the use of potentially inappropriate anti-epileptic medication. Since the publication of this National Sentinel Audit, a number of initiatives have focussed on the improvement of care of people of all ages with epilepsies [4], including the publication of national guidelines for the management of epilepsies [5][6][7]. A recent review of services for children with epilepsies [4] identified a number of improvements in overall care of these children, findings echoed in the 2012 national 'Epilepsy 12' audit [8].…”

Section: Introductionmentioning

confidence: 99%

“…Since the publication of this National Sentinel Audit, a number of initiatives have focussed on the improvement of care of people of all ages with epilepsies [4], including the publication of national guidelines for the management of epilepsies [5][6][7]. A recent review of services for children with epilepsies [4] identified a number of improvements in overall care of these children, findings echoed in the 2012 national 'Epilepsy 12' audit [8]. However, there has been no more recent national review of epilepsy deaths, and recent high-profile cases suggest that poor quality of care may still be contributing to the deaths of some children with epilepsies [9].…”

Section: Introductionmentioning

confidence: 99%

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Deaths in children with epilepsies: A UK-wide study

Sidebotham

Hunter

Appleton

et al. 2015

Seizure

Self Cite

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Section: Discussionmentioning

confidence: 99%

Section: Issue Case Assessors' Examples From the Case Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Deaths in children with epilepsies: A UK-wide study

Sidebotham

Hunter

Appleton

et al. 2015

Seizure

Self Cite

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“…Training for more subtle pediatric seizure management issues is more complex yet remains in high need in the developing world. The Pediatric Epilepsy Training course developed by the British Paediatric Neurology Association is one of the few programs for non-specialist providers of varying level used with success in LMIC, 26 however impact on management changes has not yet been published. Additionally, the 1 day intense didactic workshop does not include the level of clinical skill building we have found required for rural community first level providers in our region based upon our prior work with clinical officers, wherein we found even multiple sessions of case-based lectures did not translate well into practical application of skills.…”

Section: Introductionmentioning

confidence: 99%

Development and Evaluation of a Pediatric Epilepsy Training Program for First Level Providers in Zambia

Patel

Ciccone

Nkole

et al. 2020

Global Pediatric Health

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Introduction. The developing world continues to face challenges in closing the large treatment gap for epilepsy, due to a high burden of disease and few experienced providers to manage the condition. Children with epilepsy are susceptible to higher rates of developmental impairments and refractory disease due to delays or absence of appropriate management as a result. We demonstrated that a structured education intervention on pediatric epilepsy can improve knowledge, confidence, and impact clinical practice of first level providers in Zambia. Methods. Three first-level facilities across Zambia were included. After initial pilot versions and revisions, the final course was implemented at each site. Pre- and post-intervention knowledge and confidence assessments were performed. Additionally, chart reviews were conducted prior to intervention and 4 months after completion of training at each site to assess change on management. Results. Twenty-three of the original 24 participants from all 3 sites completed the training; 48% clinical officers, 43% nurses, 9% other expertise. Of the 15 concepts tested by knowledge assessment, 12 showed trends in improvement, 7 of which were significant ( P < .05). Chart reviews demonstrated significant improvement in documentation of seizure description ( P = .008), seizure frequency ( P = .00), and possible causes of seizures/epilepsy ( P = .034). Discussion. Key elements of success to this program included hands on clinical skills building and case-based teaching, development of a program with direct and ongoing input from the target audience, and inclusion of assessments to monitor impact on clinical practice. Future studies looking at health outcomes are necessary to determine sustained impact.

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Carer evaluations of paediatric epilepsy services with and without epilepsy specialist nurse provision

Beesley

Walton

Hindley

et al. 2021

Seizure

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To compare paediatric epilepsy services with and without Epilepsy Specialist Nurse (ESN) provision on measures of carer satisfaction and accessibility of service. Methods: In Study 1, carers in Northern England (n = 69 with an ESN, n = 27 without an ESN), completed the Parent Report of Psychosocial Care Scale to measure satisfaction with service provision. A measure of accessibility of service was also included. In Study 2, in depth semi-structured interviews with 58 carers (51 of whom had also participated in Study 1) were examined for talk related to accessibility of service. Results:In Study 1, Satisfaction with service levels were high across all areas, (ESN areas Mdn = 9.04, IQR = 1.48, non-ESN areas Mdn = 8.29, IQR = 2.41; maximum score = 10), but with carers from ESN areas over 3 times more likely to endorse scores at the median or above relative to non-ESN areas (OR = 3.28). For accessibility, carers in ESN areas were over 5 times more likely to have a median score or higher (ESN areas Mdn = 10, IQR = 0.45, non-ESN areas Mdn = 8.4, IQR = 5, OR = 5.43). In study 2 a majority of all carers reported having made at least one attempt to contact services between appointments, for a wide range of reasons, with timely resolution reported in ESN areas, but more variable resolution occurring in non-ESN areas. Conclusion: Paediatric ESNs provide a critical and timely service to children with epilepsy and their carers.

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Guidelines, training, audit, and quality standards in children's epilepsy services: Closing the loop

Cited by 7 publications

References 15 publications

Deaths in children with epilepsies: A UK-wide study

Deaths in children with epilepsies: A UK-wide study

Development and Evaluation of a Pediatric Epilepsy Training Program for First Level Providers in Zambia

Carer evaluations of paediatric epilepsy services with and without epilepsy specialist nurse provision

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