Development of a Joint Commission Disease-Specific Care Certification Program for Parkinson Disease in an Acute Care Hospital

Abstract

BACKGROUND Patients with Parkinson disease (PD) admitted to the hospital for any reason are at a higher risk of hospital-related complications. Frequent causes include delays in administering PD medications or use of contraindicated medications. The Joint Commission Disease-Specific Care (DSC) program has been used to establish a systematic approach to the care of specific inpatient populations. Once obtained, this certification demonstrates a commitment to patient care and safety, which is transparent to the public and can improve quality of care. METHODS We formalized our efforts to improve the care of hospitalized patients with PD by pursuing Joint Commission DSC. An interprofessional team was assembled to include nurses, therapists, physicians, pharmacists, performance improvement specialists, and data analysts. The team identified quality metrics based on clinical guidelines. In addition, a large educational campaign was undertaken. Application to the Joint Commission for DSC resulted in a successful June 15, 2018 site visit. To our knowledge, this is the first DSC program in PD in an acute care hospital. CONCLUSION Using the established platform of DSC certification from the Joint Commission, we developed a program based on relevant metrics that aims to address medication management of patients with PD admitted to the hospital. Our hope is to improve the care of this vulnerable patient population.

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

“…To this end, in addressing the care of this patient population, we utilized the JC-DSC platform. We have previously detailed the development and the structure of the protocol [ 17 ]. The JC-DSC is an excellent vehicle to identify, monitor and address the care of a specific patient population [ 19 ].…”

“…We recently initiated a protocol for improving medication management for PD patients admitted to the hospital [ 17 ]. Our objectives were to assess the effects of this hospital wide initiative on proper PD medications orders, the avoidance of contraindicated medications, and the resulting effects on length of stay in the 24 months following the implementation.…”

Associations of Nonmotor Symptom Burden, Activities of Daily Living, and Fear of Falling in Parkinson Disease

“…Although patients mostly present with motor symptoms, they also experience nonmotor symptoms such as pain, sleep disorders, depression, anxiety disorder, constipation, loss of smell, and sexual dysfunction. 9,10 Nonmotor symptoms, which are commonly seen not only in advanced stages of the disease but also in early stages, can unfortunately be overlooked by patients and health professionals. However, the recognition and treatment of these symptoms can provide a substantial improvement in the quality of life of patients.…”

The Prephase Nursing in Levodopa Carbidopa Intestinal Gel Therapy

“…Patients who have PD initially respond well to medications, and then, over time, it could be necessary to increase the doses and frequency of medications leading to a more complex regimen, caused by the aggravation of the disease, as motor fluctuations and dyskinesia improvements. 3 Parkinson disease is diagnosed through a clinical evaluation of motor symptoms that include resting tremor, bradykinesia, rigidity, and impaired postural reflex. Most patients also exhibit nonmotor characteristics including autonomic dysfunction, gastrointestinal disturbances (drooling, dysphagia, constipation), dementia, psychiatric disturbances, sensory symptoms, and sleep disturbances.…”

“…However, most of the patients who use levodopa for 5 to 10 years develop disabling motor complications such as motor fluctuations and dyskinesias caused by the narrowing of the therapeutic window, because the brain concentrations of dopamine decrease. 3 Although continuous levodopa administration in the form of levodopa-carbidopa intestinal gel (LCIG) system showed not only a significant improvement in motor complications but also amelioration of patients' ability to perform activities of daily living and improved quality of life, 2 advanced stages of PD still present a major challenge for patients, healthcare professionals, and physicians. 5 It was not until the 1990s that pharmacists and neurologists from the University of Uppsala managed to formulate a methylcellulose gel capable of containing a reasonable amount of levodopa/carbidopa in a practically reduced volume (20/5 mg/mL) and in a ratio (4:1) that is consistent with the commonly used oral formulations.…”