Use of prophylactic antiepileptic drugs (AEDs) is recommended for up to 1 week after craniotomy in seizure-naive patients with newly diagnosed brain tumors; however, they are often administered for up to 12 months after surgery in this patient population.
Therefore, researchers implemented a quality improvement project to improve adherence to evidence-based prophylactic AED guidelines. The results of their project were published in the Journal of the Advanced Practitioner in Oncology.
The 16-week intervention program incorporated education sessions for providers, provider alerts, documentation templates, and weekly audits and feedback. The researchers audited patient charts from 2 groups of patients before the intervention and 1 group of patients after the intervention, as well as survey the 4 providers both before and after the intervention.
Outcome measures included guideline adherence rates and AED prescription rates, which were obtained from chart review, as well as provider attitudes and knowledge assessed in a 14-item survey adapted from the Antimicrobial Stewardship Pre-Post Implementation Provider Survey by the Centers for Disease Control and Prevention.
Providers’ adherence to the guidelines increased significantly with the implementation of the intervention. They demonstrated a better understanding of appropriate prescribing of prophylactic AEDs and the side effects. Prophylactic AED prescription rates during the implementation period decreased by 2.2% (P =.119) compared to 4 months prior to implementation (P =.119) and by 2.6% compared to 1 year prior to implementation (P =.072). The association between postimplementation rates and preimplementation rates at 1 year (P =.0716) and 4 months (P = .1190) were not significant.
“This project highlights the important role of provider education, provider alerts, documentation templates and audit feedback in providing guideline adherence rates,” the researchers concluded.
“This strategy can be implemented for other clinical sites nationwide that seek to increase guideline adherence to evidence-based protocols.”
Additionally, the guidelines help “avoid the potential side effects of anticonvulsant-induced cognitive, behavioral, and psychiatric issues that can impair patients’ quality of life.”
The study had some limitations. First, reports generated from the electronic health records did not discriminate between seizure-naive patients with newly diagnosed brain tumors and patients who already had brain tumors, so the data on prophylactic anticonvulsant use included both types of patients. The sample size of neuro-oncology providers was small, which the researchers suggested contributed to the lack of a statistically significant finding, and the sample size of patients also was small, given that it was conducted during the COVID-19 pandemic.
Fu DB, Kong XT, Veenema TG, Bota DA, Koirala B. Adherence to prophylactic anticonvulsant guidelines for newly diagnosed brain tumor patients: a quality improvement study. J Adv Pract Oncol. 2022;13(8):775–789. doi:10.6004/jadpro.2022.13.8.4