Objective: To describe factors associated with triggering a best practice advisory (BPA) for dopamine-blocking agents (DBA) and report preliminary outcomes in hospitalized persons with Parkinson’s disease and related disorders (PPRD).

Background: PPRD are at higher risk of complications during hospitalizations. Administration of contraindicated DBA may contribute to worse hospital outcomes. Our group previously reported the development of a BPA within the University of Rochester (UR) and showed reduction of DBA orders and administration in hospitalized PPRD after its implementation. We now examine the circumstances in which alerts were triggered, responses taken by providers, and patient-related outcomes.

Method: PPRD who were hospitalized at UR hospitals and had the BPA triggered between 1/8/2020-1/8/2021 were identified using Epic SlicerDicer. Retrospective chart review was conducted to collect information about the alerts triggered by the BPA. A preliminary analysis of patient-related outcomes was performed.

Results: BPA was triggered for 101 patients in 122 encounters. 17 encounters were excluded. Of the 105 encounters included, anesthesiology triggered the BPA most frequently (43%) and haloperidol accounted for about half of the BPA alerts (54%). DBA orders were discontinued in 88 encounters (83%), most commonly by anesthesiology for peri-operative care medications (41 encounters). DBA were ordered in 17 encounters (16%) and administered in 7 (6%). Among these 7 encounters, haloperidol was the most common DBA (57%) and agitation the most common indication (57%). Preliminary analysis of patient-related outcomes showed that median length of stay was longer (LOS) when DBA were administered vs not (21 vs 6 days).

Conclusion: The results of this study highlight the risk of frequent use of DBA in peri-operative settings. At the same time, the adherence to the BPA suggests that these DBA might be part of standardized order sets used by providers who, when made aware of risks, would be amenable to modify. On the other hand, haloperidol for agitation was the most commonly administered DBA, despite BPA recommendations. This highlights the potential treatment challenges for inpatient agitation and need for targeted strategies. Lastly, our preliminary results are in line with previous studies showing that DBA administration in hospitalzed PPRD can lead to adverse outcomes, like longer LOS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/initial-results-after-launch-of-best-practice-advisory-for-contraindicated-agents-in-parkinsons-disease-and-related-disorders/