Objective: Develop a process for Parkinson’s patients to provide individualized medication management to reduce length of stay,, mortality, 30-day readmissions, and increase patient satisfaction.

Background: Patients admitted to the hospital with Parkinson’s Disease require individualized medication regimens; however, when providers unfamiliar with patient specific medication regimens in PD patients admitted for non-neurological health issues, they often utilized hospital standard medication administration times. Dopamine blocking agents are also prescribed in this population. This alteration in care increases the risk for falls, delirium, and mortality.

Method: Our nurse-led interprofessional team consisted of pharmacists, informaticists, Movement Disorders neurologists, RN care coordinator & quality personnel. 

Patients with primary or secondary diagnosis of PD  with or without deep brain stimulator insertion. Adults >18 years, were included. Excluded persons deceased prior to 30 days post discharge and those not receiving PD medications.

A medication history and reconciliation completed  

Inpatient medication ordered and administered as they are at home

Contraindicated medications for PD patients not given 

Vizient data of observed to expected (O:E) mortality, length of stay, and readmissions was used.

Results: Baseline data had been gathered from 91 patients from May 1- August 31 of 2020. Total admissions from 9/1/2020, were 234 for the remainder of FY 2021 and 281 for FY 2022.

Those with a secondary diagnosis of PD and received a med history increased from 53% to > 75% per month, those with a review had regimens that matched their home schedule 89% of the time. Patients who did not matched only 40% of the time.

Those with a medication regimen ordered like at home increased from 54% to 83%/month

Those receiving their medications like home improved from 71% to an average of 80% for FY 2022. 

The best practice alert for potentially inappropriate medications reduced the ordering and administration from 8%  to consistently less than 5%. 

Length of stay decreased by 0.06 days, O:E decreased by 0.05, % of 30 day readmissions decreased from 11.51 to 5.08.  Patient satisfaction increase by 0.5 for those with a medication reconciliation.

Conclusion: A nurse-led multidisciplinary team improved medication regimens for hospitalized patients with PD and had reduced LOS, 30-day readmissions and O:E mortality, all while increasing patient satisfaction.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improving-inpatient-medication-management-in-hospitalized-parkinsons-patients/