Setting

This audit is particularly relevant where family carers and professional care staff look after people with intellectual disability and epilepsy, at home, in day care, in respite care and in the community.

Background

Epileptic seizures occur in a third of patients with severe intellectual disability. Previously it was common practice to attempt to treat status epilepticus with diazepam per rectum, but this can be difficult without appropriate training for carers and be embarrassing and undignified for the patient.

Standards

No national standards were available at the time. Seven good-practice standards were set, after discussion with professionals and carers:

ᐅ Adequate information is provided to carers regarding

ᐅ The rationale for use of diazepam per rectum is explained.

ᐅ Clear written guidelines are provided for the timely administration of per rectum diazepam in relation to the first and second doses.

ᐅ Adequate training is given on the administration and dose of per rectum diazepam.

ᐅ Adequate information is provided on recognising the following complications after prolonged or repeated seizures:

ᐅ Adequate information is provided on when to call 999 for an ambulance.

ᐅ From the guidelines provided and training received, does the carer feel confident

Method

Data collection

All patients with intellectual disability and epilepsy identified as receiving or being prescribed diazepam per rectum for prolonged and/or repeated seizures over the audit period were included. Questionnaires were sent out to home carers, the day centre key worker or other staff and staff of respite care homes. An explanatory letter was provided explaining the aims and scope of the audit.

Data analysis

The percentage of the sample meeting each standard was calculated.