Timely administration of Parkinson medication in Emergency Department

Project Title:  
Timely administration of Parkinson medication in Emergency Department  

Background:  
This project was started to ensure that patients admitted to the emergency department with a known diagnosis of Parkinson’s disease are receiving their anti-parkinsonian medications in a timely manner. This would help manage their symptoms, prevent complications, decrease their length of hospital stay and lessen the diagnostic burden on the department.  

Project methodology:  
Data source for identifying the audit population: Patient notes and discharge summaries  
Audit population: Patients with known Parkinson’s Disease admitted to ED  
Sample size: 41
Data collection method: Retrospective 
Time period is being used to identify the population: 01/02/2022 to 01/03/2022 

 
Results: Of the 41 patients, only 30 were on anti-parkinsonian medications and did not administer the medication themselves, 13 patients missed 1 dose, 3 patients missed 2 doses and 4 patients had delayed doses. In 6 patients alternate medications were applicable due to patient/local factors. These were correctly prescribed and given to 2 out of 6 patients.  

Conclusion: More than half of the patients (56.6%) on anti-parkinsonian medications, attending the emergency department, are either getting delayed doses or missing doses of their time critical medication. We found that although doctors are prescribing the correct medications and doses in 95% of the cases, only 33.4% of patients received appropriate alternative medications when patients could not take their regular medications. The majority of the administration delays and missed doses are happening due to the long waiting times (2-10 hours) to be seen by a doctor. 

Interventions/Actions:  
1. Escalation for Prescription of medication on Initial Nurse assessment(within 15 minutes)  
2. Time critical medications Flash Card for doctors including trust guidelines on anti-Parkinson medications and alternatives