Audit on inpatient management of Parkinson’s disease medications

Introduction

The National Patient Safety Agency identified “PD medications as critical” making any omissions or delays in PD medication administration a patient safety incident. In 2006 the “Get it on time” campaign was launched by Parkinson’s UK to improve Parkinson’s medication administration in hospital.

Objective

To assess how well PD medications are managed amongst hospital in-patients suffering from PD.

Method

Twenty-three patients were identified from January to April 2015 who were on PD medications admitted at George Eliot Hospital. Case notes were retrospectively analysed to assess whether medications had been accurately recorded, administered on time and whether self-medication had been considered.

Results

Results were analysed considering following 4 standards:

Standard 1 – Medication accurately documented on admission

Accurate medication history was taken in 44% patients but surprisingly 78% patients were prescribed correct medications on drug chart.

Standard 2 – All patients must have their first dose of PD medications given on time and all patients should receive all their medications

Only 35% patients were given their first dose on time and 17% patients received all of their Parkinson’s disease medications on time during their admission.

Standard 3 – Patients are able to self-medicate if able was it considered/documented

Only 1 patient (4%) was able to self-medicate during hospital admission.

Standard 4 – Reasons for PD medications missed or omitted documented

97 doses of PD medications were missed or omitted across all patients during their admission. The commonest reason documented for non-administration of medication was- no reason documented (29%), nil by mouth (26%) and the drug not found (17%).

Conclusion

This study demonstrates the real need to raise awareness and emphasize on the correct history taking and documentation of PD medication. Also important is the timing of prescription and administration. If patient is well enough they should be able to self-medicate, empowering them to take control of their own medication. There can be genuine difficulties in administering the medication but they should be well documented and alternatives considered.

Recommendations

• Education and training of junior doctors and nursing staff.
• To make the of stock commonly used PD medications available in AMU/COE ward with the help of pharmacy
• Patient empowerment – enabling and encouraging patients to self-medicate when able
• Develop guidelines for patients with PD who are nil by mouth
• Repeat audit in 6 months’ time.