Audit of the Specialist Epilepsy Service for People with Learning Disabilities
Miss Felicity Trimmer, Miss Hayley Austin, Mrs Louise Gannon and Dr William Howie, Joan Bicknell Centre, Wandsworth
AIM: To review epilepsy management against current recommendations, including NICE guidelines, in a learning disability service from 2011-2012 and compare with our previous review in 2009-2010.
METHOD: We assessed clinical documentation against best practice. All documentation for patients under the care of the service in both 13-month periods were reviewed. Information on quality and location of seizure description, psychological and behavioural issues and risk assessment documentation was gathered on a retrospective basis.
RESULTS: We found: Quality of Seizure Description - Detailed (69%), Brief (20%), Identified by name only (5.5%), No description (5.5%). Location of seizure description - Clinic letter (41%), other locations such as rescue medication plans and as a separate document (59%).
Documentation of psychological and behavioural issues had risen to 82.5% and 79.5% respectively, and co-morbidity data had risen to 94.9% after an initial fall of 13% from an audit carried out in 2008.
Risk Assessment was discussed in 90% of patients (37% in 2010), with specific discussion of risk of osteoporosis in patients taking enzyme-inducing anti-epileptic drugs in 67.9%.
CONCLUSION: The audit demonstrates that the service continues to demonstrate many areas of good practice. Good documentation is seen for seizure diagnosis/description/assessment and psychological and behavioural issues. Current anti-epileptic drug documentation and detailed treatment plans are now standard practice. Although largely improved, the varying quality and location of seizure description, as well as those missing descriptions entirely, emphasises the need for a set proforma and a timeline for each patient to contain all relevant historical information. As a result of the audit the team is developing a systematic risk assessment proforma. A concurrent audit is focusing on the development of up-to-date timelines for all patients at the Joan Bicknell Centre.