The National Institute for Health and Clinical Excellence (NICE) guidelines for epilepsy issued in October 2004 include special considerations for the care of women with epilepsy and people with learning disabilities.

We audited our practice with four guidelines:

1. 1. Yearly structured reviews considering treatment effectiveness, tolerability, side-effects and adherence.

2. 2. Risk assessment which includes bathing and showering, using electrical equipment, sudden unexpected death in epilepsy and managing prolonged or serial seizures.

3. 3. To discuss the risk of higher mortality in people with epilepsy and learning disabilities with the individual, their family and/or carers.

4. 4. Women with epilepsy and their partners must be given information and counselling about contraception, conception, pregnancy and caring for children.

Data were collected by audit from both community and in-patient case notes. The first cycle, completed in October 2005 (n = 12), found that structured yearly reviews were done for 58% of the patients and risk assessment for 75% (but did not include sudden unexpected death in epilepsy), but no advice was given to women (0% of cases) and increased risk of mortality was not discussed (0% of cases).

After raising the awareness within the team about NICE guidelines, the second cycle completed in September 2006 showed some improvement, with structured yearly review completed in 100% of cases, risk assessment in 75%, and advice given to women in 50%; however, increased risk of mortality was still not discussed (0%).

A checklist for NICE guidelines has been included in medical notes and it was agreed within the team that if the risk of increased mortality was not discussed with patients or carers, it should be clearly documented with reasons.