Objective: To determine the efficacy of a Parkinson’s Disease (PD)-Specific Electronic Medical Record (EMR) Order Set in reducing the rate of medication mis-administration for PD patients admitted to Northwestern Memorial Hospital (NMH).

Background: PD patients are especially vulnerable to medication errors when hospitalized given the patient-specific and time-sensitive nature of their medication regimens. Our team previously performed a retrospective chart review of PD patients admitted to NMH over one year and found that 50.5% experienced medication error.1 Thus, we assembled neurology trainees, physicians and pharmacists to create a PD-Specific Order Set to enable accurate medication administration and alert providers to contraindicated medications. The Order Set was available to all inpatient teams in November 2016, with awareness raised through e-mails and meetings.

Methods: This is a single-center, retrospective chart review study of PD patients, who were admitted for at least one night and on at least one PD medication, to NMH in the year after our PD-Order Set institution. EMRs were reviewed in detail to ascertain the impact of the Order Set’s utilization.

Results: A total of 126 admissions of PD patients were reviewed [Table 1]. The PD-Order Set was only used during 15 admissions, and there were zero errors in medication administration in 12 of those admissions (80%). In the other 3 admissions (20%), there was a total of 4 mis-administrations, of which 3 were due to Rasagiline not being on formulary. Of the 111 admissions without Order Set use, medication misadministration occurred at a higher rate of 45% of admissions [Figure 1]. In 3 cases of recurrent admissions, PD-Order Set use resulted in more accurate medication timing than in previous admissions when it was not used. During one admission, Haloperidol was given prior to use of the PD-Order Set, with no subsequent use of contraindicated medications after its use.

Conclusions: Our chart review, though limited by small sample size, shows that utilization of a PD-Order Set can decrease the rate of medication misadministration, improve accuracy of medication timing, and prevent use of contraindicated medications. As these results support a role for disease-specific EMR Order Sets, we propose to increase our PD-Order Set utilization by incorporating automated EMR alerts suggesting its use, to ultimately result in improved care of our hospitalized PD patients.

References: 1.Kianirad, Y., Marvanova, M., Simuni, T.; Medications reconciliation in hospitalized Parkinson’s disease patients [abstract]. Movement Disorders 2015;30 Suppl 1:249.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-a-parkinsons-disease-specific-order-set-on-inpatient-medication-administration/