Utilising existing NHS digital systems to improve timely administration of Parkinson’s medication – A collaborative approach

Topics for discussion

Finishing our Parkinson's webinar series of 2023 with a bang join to listen and ask questions of the multi award winning team at Ayrshire and Arran.

They will be discussing how they utilised existing IT infrastructure and worked across departments to ensure that when Parkinson's patients are hospitalised they get their time critical medication on time, every time.

Objectives:

• Have a greater understanding of the importance of time sensitive medication in Parkinson’s Disease
  
• Understand how to liaise across different departments to ensure that a project become embedded in practice
  
• Learn how current technology can be adapted to enhance procedure and care for patients with Parkinson’s when an inpatient

Summary

Timely administration of Parkinson’s medication is essential to prevent the fluctuations in dopamine levels that can lead to “off” periods. Hospital admissions, however, can interrupt dosing regimes, and leave people with worsening symptoms.

NICE guidance states that levodopa should be administered within 30 minutes either side of the prescribed time, but this can be challenging in a busy ward environment.

The team at NHS Ayrshire and Arran have worked in collaboration with fellow departments to utilising existing IT infrastructure, including electronic prescribing and the wards’ electronic whiteboard system, to ensure hospitalized Parkinson's patients get their medication on time, every time.

Common challenges

At the start of the project, the team identified a number of challenges to timely Parkinson’s medication administration in hospital. There was difficulty in obtaining audits of medication administration timings, and a lack of consistency in being informed of admissions. It was not easy to identify when Parkinson’s medications were due to be administered on the ward, and there was a clear need for ongoing, more accurate, flexible auditing of medications.

The team devised a four-strand plan to use existing NHS systems to overcome the challenges.

Electronic prescribing being rolled out across the centre enabled the generation of a monthly audit, containing every administration of Parkinson’s medication within NHS Ayrshire and Arran. It presents the percentage of doses administered on time at various points throughout the day on each ward, allowing for targeted education and training efforts.

There is also a daily medication report. This lists all Parkinson’s patients in hospital, the ward they are on, and the medications prescribed, as well as the scheduled and actual time of administration. Not only does this make team aware of all relevant admissions, but it also allows them to work with wards to ensure timely delivery.

Parkinson’s medication prompts, commonly known as the Tulip system, pull information from the patient management system and electronic prescribing to the wards’ electronic whiteboards. A Tulip-shaped icon is automatically displayed next to the patient’s name on the relevant ward’s electronic white board upon admission. It changes from grey to green and flashes 30 minutes before the patient’s next scheduled dose. After an hour, if medication has not been delivered, it turns red. The Tulip system automatically follows the patient from ward to ward, should they be transferred.

The team have also implemented the Intellifront medication dashboard, which displays every administration of every Parkinson’s drug in the previous 12 months as visualisations. It allows the team to perform instant audits, by variables including ward and time of day, “at the click of a button”. Again, this enables the targeting of education, training, and support.

Pharmacy

Successful implementation of the project also required changes in the pharmacy. The team first looked at stock levels and locations, to ensure easy access to all Parkinson’s drugs, no matter where in the hospital the patient was admitted.

They also implemented an out of hours medicine finder. This utilises electronic prescribing data to inform the user if the required medication has been supplied to another clinician in the last seven days, allowing them to seek to secure the patient’s dose without contacting the on-call pharmacist.

In addition, the pharmacy team receive a daily report of newly admitted patients, and those with Parkinson’s are highlighted in red. This allows them to prioritise their workload, and take the opportunity to educate the ward on the need for timely administration.

Transferability and collaboration

Comparing figures from 2014, when the project was initiated and 2023, on time medication administration has increased from 41.27% to 75.02% across the trust. The most significant improvement was seen after the introduction of the Tulip system in 2019. Using one ward, for example, has increased timely administration from just 4% in 2019, to 70% in the last 12 months.

The success of the project was largely due to cross-department working, and the ability of the project team to build effective working relationships with ward staff. Education and training, on the benefits of timely administration to patients and workloads alike, was vital.

This approach can be adopted by any centre using electronic prescribing, and the NHS Ayrshire and Arran has offered to provide fellow Parkinson’s teams with the monthly and daily reports solutions, as well as training on how to implement them. Centres that do not have on-ward electronic whiteboards can still use the medication prompts. They can be set up as alerts devices including the ward computer, tablet or mobile phone.

So far, the team have already collaborated with multiple centres across the UK, and are currently working with colleagues in Grampian and Scarborough to implement the system.

It is also worth noting that that the system could easily be adapted to other time-critical medications in other medical conditions.