Safe Administration of Oral Baclofen in Patients with Cerebral
Palsy Lucia C. Bastianelli, RN, MSN, CPNP, David J. Fogelman, MD,
MSc
Purpose
Background and Significance
Implica6ons
Results
Implementa6on
Ø Oral Baclofen is used for
pa1ents with spas1city of cerebral
and spinal origin and dystonic
disorders.
Ø Our pa1ent popula1on consists
of children with Cerebral Palsy
who o;en require oral baclofen.
Ø Baclofen comes in tablet form
and is some1mes compounded into
liquid form for ease of
administra1on.
Ø The concentra1on of the liquid
form may vary depending on the
pharmacy.
Ø This can place the pa1ent
at risk for medica1on errors.
Ø The symptoms of Baclofen
overdose include: hypotonia, bradycardia,
respiratory depression, seizures and
death.
Ø The symptoms of under
dosing or withdrawal of baclofen
include: increase or return of
spas1city, hyperthermia, and change
in mental status, hypotension, and
itching.
Ø Administra1on of the different forms
of enteral baclofen can poten1ally
jeopardize safety to pa1ents with
spas1city.
Ø We aim to describe the
educa1onal tools we developed to
improve the safety of administra1on
of enteral baclofen.
Ø Poten1al for inconsistencies in the
concentra1on of the compounded form
may result in under-‐ or
over-‐dose errors.
Ø As a result, the decision
was made to u1lize the pill
form whenever possible. However, the
pills need to be diluted for
enteral administra1on, which is more
complicated for the families and
requires addi1onal teaching.
Ø We treat a diverse, worldwide
pa1ent popula1on with limited English
proficiency (LEP), therefore requiring
a deeper considera1on when developing
an educa1on program.
Ø As a team, consis1ng of a
physiatrist, pediatric nurse prac11oner,
and illustrator, we developed Family
Educa1on home care instruc1ons,
including illustra1ons for visual
aide, for the dilu1on and
enteral administra1on of Baclofen
tablets.
Ø This allows for safe and
consistent administra1on of oral
baclofen therefore minimizing risk of
an overdose or withdrawal. The
home care instruc1ons have been
translated into Arabic and other
languages will be forthcoming.
Ø In conjunc1on with the family
educa1on home care instruc1on, we
also provide demonstra1on to our
pa1ents and family/caregivers of the
proper methods of preparing, dilu1ng
and administra1ng of the medica1on.
Ø In order to ensure complete
understanding of the procedure we
request that the caregivers
demonstrate the steps of
administra1on for us.
Ø This feedback method coupled with
the home care instruc1ons, minimizes
risk and provides safe administra1on
of baclofen, therefore improving
quality of life for children
with Cerebral Palsy.
10 mg tablet dilu1on instruc1ons
Dosage schedule with gradual
weekly increases
5 mg tablet Dilu1on Instruc1on
Dosage schedule
with gradual weekly increases
Weekly gradual
increases to final maintenance dose
Special thanks to our Illustrator,
Brendan Whipple, and Kris1n
Erekson Barton, Project Mgr. Health
Literacy
[email protected]
