Missing Dosages and Neuroleptic Usage May Prolong Length of Stay in Hospitalized Parkinson's Disease Patients

Abstract

BackgroundParkinson’s disease patients are more likely to be hospitalized, have higher rates of hospital complications, and have an increased risk of deterioration during hospitalization. Length of stay is an important underlying factor for these increased risks. We aimed to investigate potential medication errors that may occur during hospitalization and its impact on length of hospital stay.MethodsA cross-sectional chart review of 339 consecutive hospital encounters from 212 PD subjects was performed. Medication errors were defined as wrong timing or omission of administration for dopaminergic drugs and administration of contraindicated dopamine blockers. An analysis of covariance was applied to examine whether these medication errors were related to increased length of hospital stays.ResultsA significant effect for dopaminergic administration (p<0.01) on length of hospital stay was observed. Subjects who had delayed administration or missed at least one dose stayed longer (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4). Contraindicated dopamine blocking agents were administered in 23% (71/339) of cases, and this was also significantly related to an increased length of stay (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4), p<0.05. Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1) compared to those who did not (M=5.9 days, SD=6.8). Neurologists were consulted in 24.5% of encounters. Specialty consultation had no effect on the medication related errors.ConclusionsMissing dopaminergic dosages and administration of dopamine blockers occur frequently in hospitalized Parkinson’s disease patients and this may impact length of stay. These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization.

Evaluation of medication dose omissions amongst inpatients in a hospital using an electronic Medication Management System

“…Parkinson's disease medication omissions have the potential to lead to increased length of stay and neuropsychiatric complications . Only a small percentage of levodopa‐combination medications were not given in our study; most of the reasons for non‐administration were valid and endorsed as “clinically inappropriate” or “refused”.…”

“On time ‐ every time” A new strategy for dosing levodopa in hospital

“…An internet based literature search, was conducted using terms: "levodopa", "hospital", "Parkinson's Disease", "Missed doses", "Guidelines" and found evidence of: poor prescribing practices and frequent drug administration errors in hospitalised PD patients. [3][4][5][6][7][8][9][10][11] Details of the medication administration components were extracted from the PD Guidelines (Table 1). Common themes were identified and these included: missed and delayed levodopa doses, inappropriate withholding of medications in PD patients during hospital admissions, changing drug regimens to fit hospital drug administration schedules and prescribing of contraindicated antidopaminergic drugs to PD patients in hospital.…”

“…6 PD patients with late or missing levodopa doses spent longer in hospital (8.2 days vs 3.6 days) and PD patients receiving dopamine blocking agents also experienced an increased length of stay (7.5 days vs 5.9 days). 7 In one retrospective study, PD medications were stopped, omitted, or prescribed differently in 76% of patients, leading to significant adverse events in over half of this group. 8 In another study, medications were missed in 30% of patients 5 and a US study 8 found that missed and delayed doses accounted for 48% and 44% of errors, respectively.…”

It is dopey to stop giving dopamine to hospitalized patients with Parkinson’s disease

“…metaclopramide, administration), on inpatients with PD [7,8]. Such errors were associated with increased length of hospitalization [7,8] and a higher mortality rate [7]. In one of these studies, neurologists were consulted in less than one quarter of the inpatient encounters [8].…”

“…Such errors were associated with increased length of hospitalization [7,8] and a higher mortality rate [7]. In one of these studies, neurologists were consulted in less than one quarter of the inpatient encounters [8]. A prospective study followed PD patients admitted to a hospital for various medical or surgical reasons over the course of 1 year [9].…”