Kerrie Kerrigan: Paediatric Epilepsy Nurse Maura Mackie : Paediatric Epilepsy Nurse

• Kerrie Kerrigan: Paediatric Epilepsy Nurse

• Maura Mackie : Paediatric Epilepsy Nurse

• Carmel McGinn : Adult Epilepsy Nurse

• Revised June 2016

Develop an understanding of Midazolam and how it works

• Develop an understanding of Midazolam and how it works

• Develop an awareness of the Epilepsy emergency medication plan/ care plan

• Demonstrate the correct procedure for the safe and effective administration of Midazolam

• Demonstrate appropriate first aid for seizures and knowledge of when to call an ambulance

• Used to prevent epileptic seizures developing into status epilepticus

• First line treatment for prolonged seizures in the community (NICE 2012)

• Prescribed on a named patient basis by Consultant Paediatrician, Consultant Neurologist, Consultant Psychiatrist or GP

Passes across the mucosal membranes and is absorbed into the blood stream

• Passes across the mucosal membranes and is absorbed into the blood stream

• Travels directly to the brain

• Works at nerve cell junctions

• Reduces brain excitability
• Suppresses seizure activity

• Acts within approximately 5 minutes

• 80% seizures stop within 10 minutes

• Has a half life of 90 minutes

• Almost completely cleared from body within 6 hours

Common side effects can include:

• Common side effects can include:

• Drowsiness
• Disorientation
• Agitation
• Amnesia

• Rare side effects can include:

• Excessive sleepiness
• Hypotension (low blood pressure)
• Shallow breathing

Prolonged seizures

• Prolonged seizures

• When seizure lasts longer than normal for the person

• Recurring seizures

• When one seizure follows another without the person regaining consciousness

• Seizure clusters

• Recurring seizures over a time with person regaining consciousness in between
• Can continue all day
• Not a medical emergency but requires treatment
• Depending on time between seizures Midazolam may be needed

• The Epilepsy Emergency Medication plan should include:

• Individual’s details
• Usual seizure type requiring emergency medication
• When to give emergency medication
• Dose of medication
• When to call 999
• Consent and agreement by appropriate persons

Should be available for all staff to view and agreed by:

• Should be available for all staff to view and agreed by:

• Person with parental responsibility/carer

• School teacher, respite/day centre manager etc.

• Doctor/named nurse

• Copy to be held parent/carer & named nurse

• Copy must be kept with the emergency medication in a safe place, at room temperature.

• Updated yearly or more frequently if required by the Named Nurse.

• Only those staff trained in administration of rescue medication can give this to the individual. A list of these names must be kept by the manager/ principle.

Provide appropriate First Aid and Time the seizure.

• Provide appropriate First Aid and Time the seizure.
• Check the airway and clear any excess saliva away with a tissue (or nasal secretions if using intranasally)
• Check the individual’s details with their emergency medication plan and product available.
• Check Expiry date of midazolam solution
• Check If using midazolam solution that it is clear and there are no white particles.

Remove cap from prefilled syringe. If using midazolam solution draw up prescribed amount.

• Remove cap from prefilled syringe. If using midazolam solution draw up prescribed amount.

• Insert the syringe into the space between the inside of the cheek and the teeth (Buccal cavity)

• Slowly administer approx. half the liquid

• Repeat the process in the opposite side

• If the individual is lying on their side, insert all the midazolam into the lower side

• Gently hold lips together for approximately 30 seconds

• Record time midazolam was administered

• Place in the recovery position as soon as seizure has stopped

• Stay with the individual and provide reassurance

You think the individual needs urgent medical assistance

• You think the individual needs urgent medical assistance

• If the emergency medication fails to have effect, any breathing difficulties, recovery is slow or an injury is sustained.

• Do not give a second dose of midazolam unless this has been indicated by a consultant and documented within the EEMP/ careplan.

Observe individual:

• Observe individual:

• Breathing & colour
• Response to medication
• Any injuries
• Remain with individual & offer reassurance
• Dispose of equipment safely & wash hands
• Inform parent/carers as per plan
• Record all details as per local policy

www.medicinesforchildren.org.uk

• www.medicinesforchildren.org.uk

• www.youngepilepsy.org.uk

• www.epilepsyaction.org.uk

• www.nice.org.uk The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. NICE guidelines [CG137]

www.medicinesforchildren.org.uk

• www.medicinesforchildren.org.uk

• www.youngepilepsy.org.uk

• www.epilepsyaction.org.uk

• www.nice.org.uk The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. NICE guidelines [CG137]