Epilepsy Awareness and the Administration of Buccal Midazolam - Full Day

Duration: 6 hours

Delegates: Those who work with or have contact with Adults or Children and who have some knowledge and experience of caring for a person with epilepsy.

• This course is delivered in line with the Joint Epilepsy Council Guidelines
• See the core components at the end of the course outline

This training facilitates safe and appropriate administration of this medication providing all the necessary guidelines, policies and procedures are in place and followed.

Assessment of learning is carried out during the course through observation, participation and questions and answers. Certificates of attendance are issued if satisfied that learning has taken place.

Due to the practical component, places are restricted to 12.

Buccal Midazolam is an emergency rescue medication prescribed under special license by a doctor to reduce the duration of or stop prolonged or continuous seizures and prevent status epilepticus and the potential risks. It is administered by a trained person to the buccal mucosa (between the gums and cheek) and is becoming increasingly popular due to its effectiveness in stopping seizures and its social acceptability. Prompting its inclusion in the National Institute for Health and Clinical Excellence (NICE) clinical practice guideline on the diagnosis and management of epilepsy in children and adults published in 2004. NICE recognise that rectal diazepam is recommended in the majority of cases, however in situations where it is not acceptable to use rectal diazepam, buccal midazolam is an alternative.

Although midazolam is a licensed drug, the use of buccal midazolam for the treatment of prolonged or continuous seizures is as yet unlicensed. The Royal College of Peadiatrics and Child Health document "The use of Unlicensed Medicines or Licensed Medicines for Unlicensed Applications in Paediatric Practice - a policy statement produced by the joint RCPCH/NPPG Standing Committee on Medicines" gives useful guidance on the use of unlicensed medication - www.rcpch.ac.uk/puplications/formulary-medicines.html. (JEC Statement on Buccal Midazolam from the guidelines on training standards for the administration of Buccal Midazolam 2005)

Buccal Midazolam should be used according to an agreed protocol drawn up by the specialist and only used following training (NICE2004) Best Practice recommendations are that the prescriber discusses the use of buccal midazolam with a Consultant or someone with a special interest in its use (Joint Epilepsy Council (JEC 2005). Buccal Midazolam is prescribed by a medical practitioner and that clear guidelines in the form of a care plan giving all the relevant details and those authorised to carry out the procedure should accompany this (Joint Epilepsy Council (JEC 2005).

Course Content:

Epilepsy Awareness Covering:

• Definition of epilepsy
• Epilepsy the facts
• Causes and diagnosis
• Classification and management of seizures with supportive video footage
• When to call an ambulance
• Triggers and precipitants
• Need to know points
• Observing and recording
• Epilepsy and mortality
• Psychosocial workshop including group specific scenarios, information and support
• Anti-epileptic drug therapy

The Administration of Buccal Midazolam

• Status epilepticus
• What is Midazolam
• Uses in epilepsy, and other conditions
• Appropriate doses
• Practical demonstration and DVD demonstration
• Possible difficulties in administration
• Overdose identification / action
• Action if midazolam is ineffective

Health and Safety

• Organisational policy/protocols
• Individual care planning and recording
• Risk assessment/promotion of safety
• Duty of care issues
• Ethical and legal responsibilities
• Recap question and answer session Evaluations

Learning Outcomes:

• Students will gain understanding of and confidence in the management and accurate recording of different seizure types
• All will be able to recognise the emergency situation and act as appropriate
• All will develop an understanding of the theory & practice of administering buccal midazolam, and will have participated in the simulated procedure
• Training will facilitate best practice guidelines and ensure that all will have the practical skills and knowledge to provide a safe, effective environment for people with epilepsy

Joint Epilepsy Council Guidelines (JEC 2004)

A guideline on training standards for the administration on rectal diazepam

"This document is intended as a guideline for those purchasing as well as those delivering training in the administration of rectal diazepam. It is hoped that it will provide guidance to local authority registration and inspection teams and help to establish a minimum standard of training which will apply throughout the UK and Ireland."

Core Components:

• Epilepsy awareness
• The administration of buccal midazolam
• Health and safety issues
• Opportunity for discussion

(The Guidelines can be purchased from the JEC at the cost of £5.00) See the links page