An Audit of Inpatient Parkinson's Disease Management at Barnet and Chase Farm Hospitals

Abstract

Background As a chronic disorder Parkinson's disease (PD) is mostly managed in outpatient clinics and primary care. Admission of PD patients is often the result of complications or associated comorbid disease. A wealth of literature identifies the problems associated with inpatient PD care, in particular inadequate and untimely delivery of dopaminergic agents after admission is a recurrent problem. This was specifically noted within a recent National Patient Safety Alert and spurred the ‘Get It On Time’ campaign run by the Parkinson's Disease Society. Aim To assess the inpatient management of PD across Barnet and Chase Farm NHS Trust with a view to highlighting areas of strength and areas for service improvement. Methods We completed a retrospective case note, drug chart and electronic patient record review for all patients admitted with a coded diagnosis of “Parkinson's Disease” (ICD10 code: G20). Only patients with idiopathic PD were included. Correct medication regimes were identified from previous clinic letters and GP faxed documents. Results Our search identified 24 patients with idiopathic PD. Their length of stay varied from 3 to 120 days (average 25). 4 patient's charts were missing from their notes. 50% had correct prescriptions of medication and timing of doses, 35% had the correct medication prescribed but incorrect timing, and 15% had incorrectly prescribed drugs and regimes. A delay in receiving the first dose of dopaminergic agent was experienced by 70%, ranging from 3 to 72 hours (average 13.6). Antidopaminergic agents were administered for aggression in one case and the patient experienced increased rigidity as a result. Laxatives were prescribed in 75% of cases. 10% of patients administered their own medications. We are now presenting our findings locally and producing an inpatient PD guideline. We plan to re–audit after these interventions. Conclusion Similar to previous studies, we have found that PD drugs are often incorrectly prescribed following hospital admission. Lack of awareness of the importance of prompt dopaminergic agent administration in this vulnerable group can lead to poorer outcomes such as increased length of stay and PD associated complications. Levodopa is often not available in A&E and non–neurology wards, which is a frequent reason given for delayed and missed doses.

Parkinson Disease Associated Differences in Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis

“…Potential explanations include the development of post-operative altered mental status, medication mismanagement, poor reserve or poorer baseline functional status. Studies have shown that up to 50% of PD patients do not receive their medications on time and may not receive the correct medications, resulting in worsening mobility, and increased risk of acute delirium due to dopamine withdrawal [32]. In a study examining post-operative medication management, antidopaminergic medications were prescribed in 24/59 admissions, which can aggravate PD symptoms, contribute to altered mental status, trigger delirium and may result in a longer hospital stay [33,34].…”