[AVBC 2025] Reducing Prolonged Use of Prophylactic Anti-Epileptic Drugs In Traumatic Brain Injury Patients
Care Process & Redesign
Appropriate & Value-based Care Conference
SingHealth
3 December 2025
To reduce the prolonged use of prophylactic anti-epileptic drugs (AEDs) in traumatic brain injury (TBI) patients from 54% to. This QI initiative demonstrated a statistically significant improvement in compliance with guidelines for prophylactic AEDs duration.
Year Submitted: 2025
Published Date: 03 December 2025
Tags: Care Process ＆ Redesign, Productivity, Cost Saving, Time Saving, Quality Improvement, Workflow Redesign, Value Based Care, Safe Care, Adherence Rate
About this Content
Aims
To reduce the prolonged use of prophylactic anti-epileptic drugs (AEDs) in traumatic brain injury (TBI) patients from 54% to 20% within a neurosurgical unit in Singapore General Hospital over a three-month period.
Background
Prophylactic AEDs are frequently prescribed following TBI to prevent seizures. However, established guidelines recommend a limited duration of one week. Beyond one week, AEDs use does not prevent late seizures and prolonged use is associated with adverse effects such as sedation, ataxia, and hyponatremia, particularly in older adults, or severe reactions like Steven Johnson syndrome.
Methods
A 5-Why diagram was used to analyze the root causes. A multi-faceted intervention was implemented from September to December 2024, including educating clinicians on appropriate indications and guidelines for prophylactic AEDs use in TBI, placing reminder signage on clinician's computers to prompt review of AEDs stop dates, and issuing bi-weekly reminders and intervention notes from pharmacists via the Sunrise Clinical Manager System. Data on AEDs prescription duration were collected pre-and post-intervention.
Results
Post-intervention, the percentage of TBI patients with AEDs discontinued after one week significantly increased from 46% (94/200) to 87% (122/140) (p0.001). This shift was reflected in the post-implementation median line across 6 data points. Based on the reduction of inappropriate prolonged AEDs prescription, SGD 16.80 was saved per episode. In addition, 10 minutes of pharmacist's intervention time was saved from clarification to drug order amendment per patient.
Conclusion
This QI initiative demonstrated a statistically significant improvement in compliance with guidelines for prophylactic AEDs duration in TBI patients, leading to reduced prolonged AEDs use and potential cost savings. Sustainability plans include continued reminders, expansion to other campuses, determining appropriate AEDs duration for other neurosurgical conditions, and collaboration with health information systems for protocolized ordering and automated reminders.
Lessons Learnt
Educational sessions, reminder signage, and pharmacist interventions led to a substantial increase in appropriate AEDs discontinuation within one week, improving from 46% to 87%. This improvement was sustained over six months, demonstrating the interventions' durability.
Keywords
Prophylactic, Anti-Epileptic, Traumatic Brain Injury, Quality Improvement, Cost Saving
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | SingHealth |
Organization(s) Involved | Singapore General Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Neurology |
Project Lead(s) | Jai Rao |
Project Member(s) | Cheok Pok Gek |
Connect with this contributor!
Jai Rao - jai.rao@singhealth.com.sg