Abstract
Parkinson's Disease (PD) is a progressive neurological disorder for which there is currently no cure. Palliative care should be discussed as part of PD management, both to empower patient understanding and expectations of their condition and to avoid unnecessary hospital admissions
Results from the 2022 Parkinson’s UK national audit, found that the elderly care PD service in York was underperforming in having advance care planning (ACP) discussions with PD patients. The aim of this quality improvement project is to further review ACP discussions on a larger sample size and improve practice in this area.
Our sample included 100 people with idiopathic PD within the Vale of York who had been seen by a PD specialist in the month of November. Clinic letters from all PD specialist involvement were read, alongside any letters from other specialities, discharge letters from hospital and general practice encounters to look for any documentation of ACP discussions.
Results showed that 82 patients had no documentation of any discussions on ACP. This population included patients in nursing homes, needing package of care, patients with Rockwood frailty scores >6 and patients showing signs of deterioration in their condition.
It is clear from the data that these discussions are not occurring as often as they should. Simply doing this QIP has raised awareness within the team and anecdotally, improvement in performance has already been noted. Further discussion and presentation of the QIP findings are to be presented at clinical governance meetings to provide further education. Data will then be reaudited.
Further change options following discussion and education could include clear documentation strategies for ACP helping to link between primary and secondary care. It should be noted that our service does not provide a Parkinson’s nurse who would often instigate ACP discussions.