Exploring carer perceptions of training in out-of-hospital use of buccal midazolam for emergency management of seizures (2008-2012).

AIM

This study aims to explore carer perceptions of training in out-of-hospital use of buccal midazolam for emergency management of seizures.

METHODS

A random sample of 100 families (from n = 198) who underwent training at the Sydney Children's Hospitals Network, Randwick campus (2008-2012) were invited to participate in a telephone questionnaire.

RESULTS

Sixty-three carers participated. Thirty-three children were female, median age at training was 4 years and seizure onset 2.75 years. Seizures were generalised in 26 children and focal in 37. Common reasons for prescription included history of prolonged seizures (38%), recent diagnosis of epilepsy (33%) and overseas travel (11%). Ninety-eight per cent of carers reported that training instructions were clear, and 94% reported the risks of using benzodiazepines were satisfactorily explained. Ninety per cent felt confident to administer the drug following training and 62% completed first aid training as recommended. Suggestions for improvement included follow-up/review and additional demonstration/practice. Twenty-one carers (33%) reported giving buccal midazolam a median five times, 67% reported it was effective in terminating the seizure and 71% called an ambulance as instructed. Problems reported in administration included excessive secretions and difficulties drawing up the solution. One child experienced breathing difficulties requiring oxygen by the paramedics. Four children were admitted to children's intensive care unit with status epilepticus requiring intubation.

CONCLUSIONS

Training for out-of-hospital use of buccal midazolam was considered valuable by carers. Only a third of the sample subsequently used midazolam. Half of these carers reported problems in administration and one reported respiratory difficulty. These results highlight the importance of drug safety and efficacious training programmes.