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.
