Journal of Pediatric Epilepsy 2017; 06(04): 169-173
DOI: 10.1055/s-0037-1606558
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Comprehensiveness of Pediatric Antiepileptic Prescribing in Clinic Letters: Are We Communicating Well?

Christopher J. Butler
1   Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, United Kingdom
,
Mohamed O. E. Babiker
1   Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, United Kingdom
› Author Affiliations
Further Information

Publication History

01 July 2017

04 August 2017

Publication Date:
05 September 2017 (online)

Abstract

This study aims to determine the comprehensiveness of pediatric epilepsy outpatient clinic letters in a tertiary pediatric neurology center with particular focus on the prescribing instructions. A retrospective study was conducted for all pediatric outpatient epilepsy clinic letters between August and October 2016. This study was undertaken in a tertiary pediatric neurology department at the Bristol Royal Hospital for Children, United Kingdom. A total of 160 patients were identified during the time period and included in the study. Letters were evaluated for the following information: patient demographics, inclusion of problem list, and medication details including the clarity of prescribing instructions. The comprehensiveness of letters was scored out of nine based on the nine categories; weight, diagnosis list, medication list, dose in milligrams, dose equivalence in milligrams/kilograms/day, formulation, strength or concentration of medication, if applicable is the volume of medication provided and is the trade name provided. A total of 94% of letters had a diagnosis or problem list provided which was clear. Only 68% letters had a separate medication list provided. The dose of antiepileptic drugs (AEDs) in milligrams was provided in 95% of letters. The formulation of the AED was provided in only 30% of letters. Only 24% of letters where a category 1 AED was prescribed had the trade name provided. This study has demonstrated significant omissions from outpatient pediatric epilepsy letters. The omissions presented in this study may culminate in inefficient communication and increased morbidity. We share practice improving learning points for writing comprehensive letters which we believe can be generalized to other pediatric specialties.

Funding

None.


Note

The authors attest that they have obtained appropriate permissions and paid any required fees for the use of copyright protected materials.


 
  • References

  • 1 Fox AT, Palmer RD, Crossley JGM, Sekaran D, Trewavas ES, Davies HA. Improving the quality of outpatient clinic letters using the Sheffield Assessment Instrument for Letters (SAIL). Med Educ 2004; 38 (08) 852-858
  • 2 McConnell D, Butow PN, Tattersall MH. Improving the letters we write: an exploration of doctor-doctor communication in cancer care. Br J Cancer 1999; 80 (3-4): 427-437
  • 3 Addison AB, Watts S, Fleming J. Effective communication between ENT and primary care-a survey of outpatient correspondence. Clin Otolaryngol 2015; 40 (03) 191-196
  • 4 Murphy AP, Bentur H, Dolan C, Bugembe T, Gill A, Appleton R. Outpatient anti-epileptic drug prescribing errors in a Children's Hospital: an audit and literature review. Seizure 2014; 23 (09) 786-791
  • 5 Medicines and Healthcare products Regulatory Agency. Drug Safety Update date volume 7 issue 4, November 2013: A1. Available at: https://www.gov.uk/drug-safety-update/antiepileptic-drugs-new-advice-on-switching-between-different-manufacturers-products-for-a-particular-drug . Accessed August 06, 2017
  • 6 Keränen T, Riekkinen P. Severe epilepsy: diagnostic and epidemiological aspects. Acta Neurol Scand Suppl 1988; 117: 7-14
  • 7 Forsgren L, Beghi E, Oun A, Sillanpää M. The epidemiology of epilepsy in Europe-a systematic review. Eur J Neurol 2005; 12 (04) 245-253
  • 8 van den Hombergh P, Künzi B, Elwyn G. , et al. High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands. BMC Health Serv Res 2009; 9: 118
  • 9 Faught E, Duh MS, Weiner JR, Guérin A, Cunnington MC. Nonadherence to antiepileptic drugs and increased mortality: findings from the RANSOM Study. Neurology 2008; 71 (20) 1572-1578
  • 10 Hovinga CA, Asato MR, Manjunath R. , et al. Association of non-adherence to antiepileptic drugs and seizures, quality of life, and productivity: survey of patients with epilepsy and physicians. Epilepsy Behav 2008; 13 (02) 316-322
  • 11 Crossley GM, Howe A, Newble D, Jolly B, Davies HA. Sheffield Assessment Instrument for Letters (SAIL): performance assessment using outpatient letters. Med Educ 2001; 35 (12) 1115-1124
  • 12 Packham B. How to improve compliance with antiepileptic drugs. Prescriber 2009; 20 (03) 12-20
  • 13 Sabaté E. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003: 87-95
  • 14 Deacon K, Wigglesworth S. Epilepsy Prevalence, Incidence and Other Statistics. Leeds, United Kingdom: Joint Epilepsy Council of the UK and Ireland; 2011: 3-4
  • 15 Heaney DC, Sander JW. Antiepileptic drugs: generic versus branded treatments. Lancet Neurol 2007; 6 (05) 465-468
  • 16 Johnson EL, Chang YT, Davit B, Gidal BE, Krauss GL. Assessing bioequivalence of generic modified-release antiepileptic drugs. Neurology 2016; 86 (17) 1597-1604