Background Seizures are a distressing event, especially in patients at the end of life, when a significant proportion also lose the oral route for medications. Recently, an evaluation was done concerning medications Palliative Care physicians prescribe in these situations. This project aimed to evaluate how acute hospital clinicians manage seizures at the end of life. We also aimed to assess the knowledge of different routes of delivery for seizure medication at the end of life.
Methods Physicians within University Hospital Southampton (Stroke Medicine, Oncology and Neurology) were selected to take part in on online survey.
Results At the time of writing, there were 14 responses. Of the routes available for medication: 93% identified oral and IV, 71% Subcutaneous and Per rectum, 36% Nasogastric tube and 14% PEG, Intramuscular, Buccal and Sublingual. The most frequently used route was oral. Of medications available subcutaneously, Midazolam was identified by 57%, Levetiracetam by 29%, Phenobarbitone by 21% and Clonazepam by 7%. 71.4% said that the consciousness of the patient affected their choice of medication. 29% said they were ‘not so confident’ managing seizures at the end of life, but the rest were at least ‘confident’. 86% would contact Palliative Care for assistance.
Discussion/Conclusion Within this population, there is good knowledge of routes to use other than oral, but low incidence of use. Few doctors could identify many drugs available subcutaneously, and many were not confident in managing active seizures towards the end of life. Most would use the level of consciousness of the patient as a guide when prescribing. It is clear that educating physicians about options when the oral route is lost would be beneficial to confidence and patient care.
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