Adherence to a strict medication protocol can reduce length of stay in hospitalized patients with Parkinson's Disease

Abstract

Background Patients with Parkinson's Disease (PD) are at higher risk of complications when admitted to the hospital. Delays in PD medications and use of contraindicated medications contribute to the increased risk and prolong their lengths of stay (LOS). Using a hospital-wide PD protocol, we aimed to ensure PD medications were placed with “custom” timing to resemble the home schedules, and also to avoid ordering or administering contraindicated medications. Material and methods 569 patients admitted in 2017 and 2018, were reviewed retrospectively. Mean age was 76.5 (SD 10.6), 332 were males and 237 were females. Charts were reviewed to assess if A) PD medications were ordered with custom timing, B) if not, were the orders changed to custom timed C) if contraindicated medications were ordered, and D) if they were administered. We also assessed the actual/expected length of stay during this time period. Chi Square and post hoc analyses were done to compare time points. Poisson regression analysis was done to assess relative improvement of variables. Results There was a 2.7 fold increase in orders placed with custom timing in 2018 compared to 2017 (RR = 2.651, 95%CI: 1.860–3.780, p < 0.0001), and a 3.2 fold increase in correction of non-custom orders in the same time period (RR = 3.246, 95%CI: 1.875–1.619, p < 0.0001). We also observed a decrease in the actual/expected LOS ratio from 1.54 to 1.32 (p < 0.05). Conclusion By utilizing an established platform for quality improvement, we were able to improve adherence to the home medication regimen timing in admitted PD patients. Our findings also suggests that adherence to a strict medication regimen protocol may decrease LOS for this patient population.

Standardizing default electronic health record tools to improve safety for hospitalized patients with Parkinson’s disease

“…The HUMC team was able to successfully add the “Custom” option as a default frequency for selected PD medications for which timing is critical and eliminate the default frequency settings (non-custom) options from being available to choose ( Figure 2 ). With these changes, HUMC saw nearly a threefold increase in appropriate (custom) placement of PD medication orders ( Azmi et al, 2020 ).…”

Investigating the Effect of Adherence to Antipsychotic Therapy on the Length of Stay and Number of Hospitalizations in Patients with Schizophrenia – A Descriptive Analysis

“… 46 Another study on Parkinson's Disease stated that strict protocol adherence to the therapy could reduce LOS with a decrease in the actual/expected LOS ratio from 1.54 to 1.32 (p < 0.05). 47 The dosage form is one of the factors that affect compliance. Some studies suggested that compliance could be maintained significantly more effectively when using injectable antipsychotics compared to oral antipsychotics.…”

“…However, some studies stated that LOS was not statistically significantly reduced in patients receiving LAIAs following treatment with oral antipsychotics. 23 , 47 , 48 Meanwhile, another study showed that LOS was associated with patients discharged from hospital [aOR: 3.65 (1.66–8.01), p = 0.001] and treatment for antipsychotic extrapyramidal side effects during hospitalization [aOR: 3.45 (1.32–9.03), p = 0.012]. Patients who had more interactions with medical providers during psychotic episodes prior to presentation at the unit were less likely to have a long LOS [aOR: 0.35 (0.16–0.76), p = 0.008].…”

Peri‐operative management of patients with Parkinson’s disease

“…The patient's usual schedule of antiparkinsonian medications should be maintained peri-operatively if enteral intake is permitted. Adherence to the patient's home schedule, education of healthcare providers on the importance of medication timing and avoidance of contraindicated drugs have all been shown to shorten the duration of hospital stay [14]. This can be a challenge for patients with advanced disease requiring frequent dosing or for patients who cannot receive oral medication due to fasting or surgical considerations.…”