Integration of Nurse Teaching in Pediatric Epilepsy Clinic to Proactively Address Patient Medication Concerns

Epilepsy is one of the most common neurologic diseases in the world. Managing this chronic disease can be complex, and value-based healthcare relies heavily on outpatient care teams to play a vital role in educating patients and caregivers about disease management, especially regarding anti-seizure medications (ASMs), the primary treatment option. Traditional outpatient provider-based clinic models focus on disease diagnosis and medication choices but often lack education for medication- specific management, compliance, and safety. Local Problem: In the Division of Pediatric Neurology at the University of Utah, nurses handle most post-clinic patient calls despite not being directly involved in patient clinic visits. The division receives an annual average of 7,500 incoming calls from patients, caregivers, and pharmacies, with 83% focused on medication management issues. This reactive and delayed approach to patient education and medication management strains care teams, further stresses families, and puts patient outcomes, satisfaction, and safety at risk. Methods: This quality improvement project utilized a SWOT analysis to evaluate the existing clinic visit workflow and patient education processes. A new assessment and education workflow was designed and integrated into the clinic. The new workflow was evaluated for effectiveness, feasibility, usability, and satisfaction. Interventions: From November 1 to December 31, 2023, a nurse-directed medication-focused workflow was implemented with clinic patients of one pediatric epileptologist. The new workflow utilized an eight- question medication management toolkit and addressed common medication issues identified from post- visit phone calls. Results: Forty-six patients were seen during this timeframe. All patients were screened using the 8- question medication management toolkit and received direct nurse education. An independent t-test compared the 368 responses generated by the toolkit questions asked during the clinic visit. Seventy-five percent (279) of the toolkit responses reflected a proactive intervention to address medication-related concerns or education needs before the patient left the clinic. Unexpected medication management barriers were identified in 28 (61%) patients. Conclusion: Implementing a standardized clinic workflow integrating nurse assessment and patient education using an 8-question medication management screening toolkit in a pediatric epilepsy clinic proactively addressed most anti-seizure medication management issues, typically only identified in post- visit patient phone calls. This clinic model could decrease patient phone calls and improve pediatric epilepsy patient education, satisfaction, outcomes, and safety.