DC84-Epilepsy Awareness and Seizure Management Policy

Registration Number: {{org_field_registration_no}}

Epilepsy Awareness and Seizure Management Policy

1. Purpose and Commitment

The purpose of this policy is to outline {{org_field_name}}’s commitment to providing safe, effective, and compassionate care for service users with epilepsy. Epilepsy is a neurological condition that affects the brain and causes recurrent seizures. As a care provider, we are dedicated to ensuring that individuals living with epilepsy receive person-centred support, allowing them to lead safe, independent, and fulfilling lives. This policy ensures all staff members are equipped with the knowledge and skills required to manage epilepsy effectively, respond to seizures, and provide appropriate aftercare.

2. Scope

This policy applies to all employees, including care staff, administrative staff, volunteers, and contractors. It covers the management of epilepsy for service users receiving care in their own homes, ensuring appropriate response to seizures, medication management, and promoting awareness among all stakeholders.

3. Policy Statement

We are committed to providing high-quality domiciliary care that ensures the safety, dignity, and well-being of service users with epilepsy. Our approach is rooted in person-centred care, ensuring each individual receives tailored support based on their unique needs, seizure types, triggers, and treatment plans.

4A. Legal and Regulatory Framework

This policy will be implemented in accordance with applicable legislation, regulations and current national guidance, including:

Health and Social Care Act 2008 and Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, particularly:
- Regulation 9 – Person-centred care.
- Regulation 11 – Need for consent.
- Regulation 12 – Safe care and treatment.
- Regulation 17 – Good governance.
- Regulation 18 – Staffing.
Mental Capacity Act 2005, where a person may lack capacity to make a relevant decision.
Human Medicines Regulations 2012, where applicable to prescribed antiseizure medicines.
Misuse of Drugs Act 1971 and Misuse of Drugs Regulations 2001, where applicable to controlled rescue medicines.
Current Care Quality Commission guidance on medicines for seizures and medicines management in adult social care.
NICE NG217 – Epilepsies in children, young people and adults.
Current Medicines and Healthcare products Regulatory Agency safety requirements concerning antiseizure medicines, including valproate and topiramate.
Current NHS guidance concerning seizure first aid and emergency escalation.

{{org_field_name}} recognises that diagnosis, prescribing and changes to antiseizure treatment are clinical decisions.

Care staff must not:

Diagnose seizure type.
Start or stop an antiseizure medicine.
Alter a prescribed dose.
Change the timing of treatment outside authorised instructions.
Give rescue medication other than in accordance with the person’s prescription and individual emergency management plan.

4. Understanding Epilepsy

4.1 What is Epilepsy?

Epilepsy is a chronic neurological disorder characterised by recurrent seizures caused by sudden bursts of electrical activity in the brain. Seizures can vary in type, frequency, and severity, depending on the part of the brain affected.

4.2 Types of Seizures

Seizures are generally classified into two main types:

Focal Seizures: These originate in one specific area of the brain. They may involve unusual sensations, twitching, or altered consciousness.
Generalised Seizures: These affect both sides of the brain and include subtypes such as tonic-clonic (convulsive), absence (brief loss of awareness), and myoclonic (sudden muscle jerks).

4.3 Triggers

Common triggers for seizures include stress, lack of sleep, flashing lights, alcohol, missed medication, and hormonal changes. Identifying and avoiding triggers can significantly reduce seizure frequency.

5. Epilepsy Management Plan

Every service user who requires support with epilepsy will have an individualised care plan appropriate to their needs.

Where the person’s epilepsy presents a risk of prolonged, repeated or emergency seizures, there will also be a clear individualised emergency management plan developed with appropriate healthcare-professional input.

The plan will include, where applicable:

· The person’s diagnosed seizure type or types.

· A description of what their usual seizures look like.

· Their usual seizure duration.

· Usual frequency or pattern.

· Known triggers.

· Warning signs or aura.

· Risks associated with their seizures.

· Appropriate seizure first aid.

· What staff should and should not do during a seizure.

· When the person’s seizure should be considered unusually prolonged.

· When rescue medication should be administered.

· The name of the rescue medicine.

· The prescribed dose.

· Route of administration.

· Circumstances or seizure duration which trigger administration.

· Minimum interval between doses where applicable.

· Whether a second dose is authorised.

· Maximum permitted dose.

· Expected effect of the medicine.

· What staff should do if the medicine does not have the expected effect.

· When staff must call 999.

· When other healthcare advice should be obtained.

· Post-seizure care.

· Any individual risks relating to aspiration, injury or breathing.

· Contact arrangements for relevant healthcare professionals.

· Recording and reporting requirements.

The plan must be:

· Person-specific.

· Current.

· Accessible to staff providing the person’s care.

· Reviewed when the person’s epilepsy, medicines or emergency arrangements change.

Generic seizure-management instructions must not replace an individual emergency plan where person-specific clinical instructions are required.

6. Medication Management

Antiseizure medicines will be supported in accordance with:

The person’s prescription.
Their medicines care plan.
Their epilepsy or emergency management plan.
{{org_field_name}}’s Medicines Management Policy.
Current CQC medicines guidance.

6.1. Routine Antiseizure Medicines

Staff providing medicines support must:

Provide only the level of support assessed and documented in the care plan.
Follow the current prescription.
Administer medicines at the prescribed time.
Record every occasion of administration or other medicines support appropriately.
Record refusals, omissions and other exceptions.
Escalate missed doses or uncertainty according to the person’s care plan and medicines procedure.
Report suspected adverse effects appropriately.

Staff must never:

Independently change an antiseizure medicine.
Change a prescribed dose.
Advise the person to stop treatment.
Withhold treatment without an authorised clinical reason or appropriate professional advice.

Missed doses of antiseizure medicines may increase seizure risk and must be managed according to the person’s individual instructions and appropriate clinical advice.

6.2. Rescue Medication

Rescue medication may include:

Buccal midazolam.
Rectal diazepam.

Where staff are expected to administer rescue medication, the person’s emergency management plan must clearly specify:

The medicine.
Strength.
Dose.
Route.
The circumstances in which it must be given.
The seizure duration or pattern which triggers administration.
Whether a second dose is authorised.
The minimum interval between doses.
Maximum permitted dose.
Expected response.
When 999 must be called.
What to do if the medicine is ineffective.

Staff must not administer rescue medication unless they:

Have received appropriate medicine-specific training.
Have completed practical training where required.
Have been assessed as competent.
Understand the person’s individual seizure presentation and emergency plan.
Have access to the current instructions at the time of administration.

Training attendance alone does not demonstrate competence.

Competence must be documented and reviewed appropriately.

6.3. Availability and Storage of Rescue Medication

Rescue medication must be:

Available when required.
Stored safely but capable of rapid access in an emergency.
Stored in accordance with manufacturer instructions.
Clearly identifiable.
Within its expiry date.
Available during outings or other situations where the person’s care plan requires it.

Staff must know where the medicine is located before providing care to a person who may require emergency administration.

6.4. Recording Rescue Medication

Following administration, staff must record:

The seizure start time.
Observed seizure characteristics.
Time rescue medication was administered.
Medicine and dose.
Route.
Person administering it.
Response to treatment.
Any second dose where authorised.
Time emergency services were contacted, where applicable.
Advice received.
Outcome.

6.5. Medicine Safety Alerts

Where a person receives a medicine subject to specific MHRA safety measures, staff will follow the person’s current clinical instructions and escalate concerns to the appropriate healthcare professional.

This may include medicines such as:

Valproate.
Topiramate.

Care staff are not responsible for determining whether these medicines should be prescribed or discontinued.

A person taking an antiseizure medicine must not be advised by care staff to stop treatment abruptly because of a safety warning, pregnancy concern or other issue.

Urgent professional advice will be obtained where necessary.

7. Seizure Response Protocol

Staff must follow the person’s individual epilepsy and emergency management plan where one is available.

7.1. During a Convulsive Seizure

Staff should:

1. Stay calm.

2. Note the time the seizure begins.

3. Protect the person from immediate hazards.

4. Move dangerous objects away where safe to do so.

5. Cushion the person’s head where necessary.

6. Loosen tight clothing around the neck where appropriate.

7. Allow the seizure to run its course unless the person’s emergency plan requires intervention.

8. Observe the person’s breathing and seizure activity.

9. Maintain privacy and dignity.

10. Administer prescribed rescue medication when the individual plan instructs them to do so and only where trained and competent.

Staff must not:

· Restrain the person’s movements.

· Put anything into their mouth.

· Attempt to force their mouth open.

· Give food, drink or oral medicine while they are not fully alert and able to swallow safely.

· Move the person unless they are in immediate danger.

Once convulsive movements have stopped:

· Check breathing.

· Place the person in the recovery position where appropriate.

· Remain with them.

· Reassure them as they recover.

· Follow their individual post-seizure plan.

7.2. When to Call 999

Staff must call 999 where:

· It is the person’s first known seizure.

· A seizure lasts longer than is usual for that individual and their plan requires emergency assistance.

· A convulsive seizure continues for 5 minutes or more, unless an immediately available individual emergency plan provides specific instructions which staff are trained and authorised to follow.

· The seizure continues for more than 2 minutes longer than the person’s usual convulsive seizure duration and should therefore be treated as a prolonged seizure emergency.

· The person has another seizure without recovering consciousness between seizures.

· The person does not recover in the way described in their normal care plan.

· The person has 3 or more seizures within 24 hours, unless their specialist emergency plan provides more specific escalation instructions.

· The person is seriously injured.

· The person has significant difficulty breathing after the seizure.

· Rescue medication has failed to produce the expected response within the timeframe in the emergency plan.

· The person’s emergency plan specifically requires an ambulance.

· Staff have another serious concern about the person’s condition.

Where in doubt about a potentially life-threatening situation, staff should seek emergency assistance.

7.3. Prolonged and Cluster Seizures

A convulsive seizure lasting 5 minutes or more constitutes convulsive status epilepticus and requires immediate emergency treatment.

A convulsive seizure lasting more than 2 minutes longer than the person’s usual seizure should also be treated as a prolonged seizure medical emergency.

Repeated or cluster seizures, typically 3 or more self-terminating seizures within 24 hours, must be treated as a medical emergency.

Where an individual emergency management plan is immediately available:

· Follow the plan.

· Administer prescribed rescue medication where indicated.

· Seek emergency or specialist help as directed.

7.4. Post-Seizure Care

Following a seizure, staff will:

· Stay with the person until they have recovered appropriately.

· Monitor breathing and responsiveness.

· Provide reassurance.

· Allow appropriate rest.

· Protect dignity and privacy.

· Check for injuries.

· Follow the person’s individual post-seizure instructions.

· Record the seizure accurately.

· Report significant changes from the person’s normal seizure pattern.

· Obtain healthcare advice where required.

The seizure record should include, where possible:

· Date and time.

· Duration.

· What happened immediately before the seizure.

· What was observed during the seizure.

· Parts of the body affected.

· Awareness or loss of consciousness.

· Breathing or colour changes.

· Injuries.

· Rescue medicine administered.

· Recovery time.

· Behaviour or symptoms following the seizure.

· Any professional advice or emergency response required.

8. Training and competency

8.1. Epilepsy Awareness

Staff supporting a person with epilepsy will receive training appropriate to their role.

Training will include, as relevant:

Understanding epilepsy.
Common seizure types.
Individual seizure presentation.
Recognising prolonged or cluster seizures.
Seizure first aid.
When to call 999.
Avoiding restraint.
Airway and recovery-position principles.
Post-seizure support.
Recording and reporting seizures.
Medicines safety.
Safeguarding and risk management.

8.2. Rescue Medication Competency

Staff who administer rescue medicines such as buccal midazolam or rectal diazepam must receive additional medicine-specific training.

Before administering rescue medication independently, the staff member must:

Have received appropriate theoretical instruction.
Have received practical instruction where required.
Understand the person’s individual emergency management plan.
Demonstrate the correct administration technique.
Understand the prescribed dose and trigger for administration.
Know when a second dose may or may not be given.
Know when to call 999.
Understand potential adverse effects and post-administration monitoring.
Be formally assessed as competent.

Competency must be documented.

Competency will be reassessed:

At the interval required by {{org_field_name}} or the healthcare professional responsible for the person’s plan.
Where the person’s medicine or administration device changes.
Where the emergency plan changes.
Following a medicines or seizure-management incident.
Where supervision identifies a concern.
Where a member of staff has not undertaken the task for a significant period.

Annual epilepsy-awareness training does not replace task-specific competency assessment.

9. Promoting Safety at Home

9.1 Environmental Adjustments To reduce risks, we will conduct home risk assessments, ensuring:

Clear walkways to prevent falls during seizures.
Protective covers on sharp furniture edges.
Accessible emergency call systems.

9.2 Assistive Technology Where appropriate, we will recommend seizure alarms, fall detectors, and smart home devices to enhance safety.

10. Communication and Partnership

We believe that effective epilepsy management requires collaboration. Therefore:

We involve service users, families, and healthcare providers in care planning.
We ensure clear communication regarding medication changes, seizure activity, and care needs.
We respect confidentiality while prioritising safety and well-being.

11. Record Keeping and Documentation

Accurate record-keeping is vital for effective seizure management. Staff will:

Maintain detailed seizure logs, noting duration, type, and triggers.
Document medication administration and any side effects.
Ensure records are stored securely and accessible only to authorised personnel.

12. Quality Assurance and Policy Review

We regularly evaluate our epilepsy management practices through:

Audits of care plans, medication records, and incident reports.
Feedback from service users and their families.
Annual reviews of this policy to reflect current guidelines and best practices.

13. Equality, Diversity, and Inclusion

{{org_field_name}} will monitor epilepsy support through:

Review of individual epilepsy care plans.
Review of emergency management plans.
Audit of seizure records.
Audit of Medication Administration Records.
Audit of rescue-medication availability and expiry dates.
Review of rescue-medication administration.
Review of ambulance call-outs.
Review of medication incidents.
Staff competency records.
Service-user feedback.
Relevant healthcare-professional feedback.
Incident and safeguarding reviews.

This policy will be reviewed at least annually, or sooner where necessary.

An earlier review will take place where:

NICE epilepsy guidance materially changes.
CQC medicines guidance concerning seizures materially changes.
MHRA safety requirements concerning antiseizure medicines materially change.
Emergency seizure-management guidance materially changes.
A person’s rescue medication arrangements expose a policy weakness.
A serious seizure-related incident occurs.
A medicines error occurs.
Staff competency concerns are identified.
Audit identifies recurring non-compliance.

The Registered Manager will ensure that policy review considers:

Individual emergency management plans.
Prolonged seizures.
Cluster seizures.
Status epilepticus.
Buccal midazolam.
Rectal diazepam.
Routine antiseizure medicines.
Medicine safety alerts.
Rescue-medicine availability.
Seizure first aid.
Emergency escalation.
Post-seizure care.
Staff training.
Competency assessment.
Recording.
Communication with healthcare professionals.

Where deficiencies are identified, {{org_field_name}} will:

Review affected care plans.
Seek appropriate clinical advice.
Review staff competency.
Provide additional training or supervision.
Review medicines arrangements.
Correct emergency procedures.
Implement corrective and preventative action.

Material policy amendments will be documented and communicated to relevant staff.

14. Conclusion

Our domiciliary care company recognises the unique challenges faced by individuals with epilepsy. Through comprehensive training, individualised care planning, and a commitment to continuous improvement, we ensure that service users receive safe, dignified, and empowering support. This policy serves as a framework for achieving excellence in epilepsy care while promoting independence and quality of life.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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