Quality Improvement in Parkinson’s Disease: A Successful Program to Enhance Timely Administration of Levodopa in the Hospital

Abstract

Background: Patients hospitalized with Parkinson’s disease (PD) require timely delivery of carbidopa-levodopa (C/L) medication. Ill-timed administration of C/L doses is associated with greater morbidity and longer lengths of stay. Objective: To understand the barriers to timely C/L administration, and implement strategies to improve the administration of the drug to hospitalized PD patients. Methods: Several key strategies were employed in 2015 to improve the timely delivery of C/L doses: 1. three kinds of nursing alert in the electronic medical record (EMR); 2. staff in-service education; 3. stocking immediate-release C/L into automated medication dispensing machines on key hospital units; 4. reports to nurse unit managers on timeliness of C/L administration; and 5. reconciliation of inpatient and outpatient levodopa orders by the hospital pharmacist upon admission. The primary outcome was the percent of C/L doses administered within 60, 30, and 15 minutes of scheduled time. Results: Our urban hospital, affiliated with a Parkinson’s Foundation Center of Excellence, had 5,939 C/L administrations in 2018. There was sustained improvement in timely delivery of doses, from 89.3% in 2012 to 96.5% in 2018 (within 60 minutes of the scheduled time), 65.5% to 86.4% (30 minutes), and 42.3% to 71.1% (15 minutes) (all p < 0.001). Conclusions: With multifaceted but relatively simple measures, we were able to “change the culture” so that hospitalized patients with Parkinson’s disease receive levodopa on time.

Identifying rates and risk factors for medication errors during hospitalization in the Australian Parkinson’s disease population: A 3-year, multi-center study

“…Initiatives such as using the adverse drug reaction box to highlight medications to avoid need to be promoted within the healthcare setting. Other initiatives that have a proven benefit in reducing medication related harm and errors in the general patient cohort [ 40 – 42 ] such as electronic health records, electronic prescribing, pharmacist involvement in accident and emergency, and partnered-pharmacist charting of medicines could also reduce these preventable errors in this vulnerable patient group [ 43 ].…”

Editorial: Hospitalization and Parkinson's disease: safety, quality and outcomes

“…Finally, our Research Topic focused on improving care for PWP. As the literature has evolved from early efforts focused mostly on identifying and better defining the hospitalization challenge, more recent efforts have focused on how processes can impact hospital safety gaps and improve patient care (Skelly et al, 2014 ; Azmi et al, 2019 ; Hobson et al, 2019 ; Nance et al, 2020 ).…”

Inpatient Parkinson’s Care: Challenges and Special Considerations

“…On the other hand, dosing too early may cause dyskinesias, which predisposes patients to falls, inability to participate in therapy, psychosis, orthostasis and syncope. [12,13] For these reasons, management of PD medication regimen is a crucial aspect of inpatient care.…”

“…Nursing education and other measures including pharmacist review of medications and improved stocking of medications have reduced length of hospital stay and improved medication administration. [13,41,42] Technology can also enable facilitation of medication administration and avoidance of contraindicated medications. The use of medication order constraints which forces custom hour/minute time orders, drug-disease interactions and missed dose timing alerts, are reminders for all healthcare providers and may be particularly helpful for those relatively inexperienced in PD inpatient care.…”