Audit of medical outpatient management of Parkinson’s disease

At the time this audit was performed I was relatively new to the field of Parkinson’s disease. The purpose of this audit was to compare my own outpatient practice of following up patients with PD with results from the National PD UK Audit 2011 which had used NICE guidance as gold standards. In particular the frequency of medical review, driving status and awareness of impulse control behaviours in patients on dopamine agonists were looked at in addition to level of enquiry of motor- and non-motor features of PD.

The demographics of my patient group were broadly similar to those in the national audit. There was not as much specialist nurse involvement in my patients but there had been a recent retirement of a nurse who had yet to be replaced.

The audit highlighted the fact that I was seeing only follow up patients and no new referrals. This was unsatisfactory because I also needed to be seeing patients in the diagnostic phase to develop my clinical skills in managing patients with PD.

The audit results showed that there was scope for improvement in my practice of enquiring about driving status, impulse control behaviours, pain and domestic activities of daily living.

Following the first audit, measures were put in to place to make improvements in the above:

1. ‘New slots’ were created in my clinic template so I could see both new and follow up patients
2. Two part-time PD nurse specialists were appointed
3. For my own practice improvement I adopted an external memory aid in the form of a sticker put in the clinical notes as a reminder to ask about driving, ICBs, pain and domestic ADLs

2016 update: I re-audited my practice following the four item reminder sticker intervention – Audit 2. All four items showed a significant improvement following the intervention.