Clinical governance: risk assessment in SUDEP

Clinical risks can be contained through risk management initiatives, and can also be used to demonstrate effective clinical governance. The purpose of this paper is to outline a new risk assessment tool that monitors the risk factors of sudden unexpected death in epilepsy (SUDEP).

A systematic review of the literature was undertaken to determine the contributory risk factors of SUDEP. A total of 18 factors were identified, of which 11 were modifiable and therefore have the potential to influence the risk of SUDEP.

The factors identified from the literature review have been populated into a Microsoft Excel® spreadsheet with drop-down boxes for the responses to each factor. No attempt has been made to rank these risk factors. Neuropsychiatrists piloting the tool in clinical practice have found the tool simple and quick to use. A printout of the checklist is placed in the patient's medical notes as evidence. Where an overall SUDEP risk rating is increasing, the clinical team can intervene to mitigate the risks.

The checklist brings together factors identified in a systematic review of the literature in order to inform clinical practice in mental health. In parallel with using the checklist in practice, a broader team is undertaking an explorative retrospective case-control research study to determine whether it is possible to rank the risk factors; this will inform a more sophisticated risk assessment tool.