(1014) Impact of Intravenous Push-Dose Levetiracetam on Time to Administration in Acute Seizure Management

Introduction: Levetiracetam (LEV) is a common second line agent used after benzodiazepines in acute seizures and status epilepticus. Rapid administration of anti-seizure medications is imperative to reduce the risk of long term sequalae. Intravenous push (IVP) LEV was implemented to expedite seizure management. The purpose of this analysis is to compare time from order verification to administration pre- and post-implementation of IVP LEV.

Methods: This is a single center, retrospective analysis of 170 adult patients who received one-time doses of ≤1500 mg of LEV pre- and post-implementation of IVP LEV over a two-year time frame. Orders were excluded if they were verified more than one hour prior to intended due time, not verified by a pharmacist (i.e. auto verification), pediatric orders, discontinued prior to administration, or if they contained multiple administrations. The primary outcome was time from verification to administration of STAT one-time LEV orders. Secondary outcomes included time from order verification to administration of routine one-time LEV orders and comparisons of time from drug verification to administration between the emergency department (ED), intensive care units (ICUs), and general floor locations.

Results: A total of 3,441 LEV orders for 170 patients were screened. Two hundred and three orders were included, with 100 in the pre-implementation group and 103 in the post-implementation group. Mean time from order verification to administration of STAT LEV orders was 38.5 minutes in the pre-implementation group and 25.3 minutes in the post-implementation group (p=0.04). Mean time from order verification to administration of routine orders was 40.2 minutes in the pre-implementation group and 33.0 minutes in the post-implementation group (p=0.54). Mean time from order verification to administration of STAT orders decreased from 50 minutes to 27 minutes in the ED (p=0.56), 35.5 minutes to 18.4 minutes in ICUs (p=0.25), and 34.2 minutes to 25.1 minutes on general floors (p=0.2).

Conclusions: The implementation of IVP LEV reduced time from order verification to administration in adult patients at a large tertiary academic medical center. This decrease in time to administration can expedite management of acute seizures and help prevent adverse effects of prolonged seizures.