Introduction Seizures account for 2–3% of presentations to the Accident & Emergency department. The National Audit of Seizure management in Hospitals (NASH) has demonstrated significant variances with regards to initial assessment and subsequent management. Standardised management protocols are crucial in optimising the care of this commonly encountered medical emergency.

Methods The care of 30 patients admitted with seizures over a 1–month period was retrospectively reviewed. Following this a trust-wide seizure bundle was implemented and another 30 patients were reviewed. Data collection specifically assessed: ▸ Demographics of patients admitted, ▸ Immediate assessment & initial investigations, ▸ Consequent neuro-imaging & specialist investigations, ▸ Referral pathway.

Results The results showed poor uptake of the bundle and consequently management was broadly unchanged. The most significant results were:

▸ 24% of cases did not have a senior review

▸ 70% of cases were not discussed with neurology

▸ 36% of cases did not have any follow up arranged

Conclusion The implementation of a seizure bundle can be challenging in the context of a unit that has a rapid staff turnover and is heavily staffed by locum physicians. Repeated staff education is required. This evidence is being used in a business case to employ an epilepsy nurse at Northwick Park. (Aravindhan Baheerathan and Kohilan Gananandan will both be presenting authors and contributed equally to this abstract).