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Improvement of Medical Management of Parkinson’s Disease in Inpatients

This project aims to increase the proportion of on-time administration of levodopa doses to Parkinson's disease patients admitted to elderly care wards to 90% over a 6-month period. The project involves process mapping, data collection, interventions, and creating awareness among medical and nursing staff.

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Improvement of Medical Management of Parkinson’s Disease in Inpatients

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  1. Learning To Make a Difference Improvement of Medical Management of Parkinson’s Disease in Inpatients Tom Stoker MA (hons.) MB B.chir MRCP(UK)

  2. Project Aim(s) • To increase the proportion of levodopa doses administered on time (no later than 30 minutes before or 30 minutes after scheduled time) to Parkinson’s disease patients admitted to care of the elderly wards, to 90% over a 6 month period

  3. Process mapping

  4. Objective Primary Drivers Secondary Drivers Driver Diagram Accurate drug history (patient, relatives, GP, clinic letters) Patient registered on electronic drug chart Medical staff: Prescription Medical team awareness of importance of administration time To increase the number of levodopa doses administered on time to Parkinson’s disease patients on care of the elderly wards Pharmacy: Drug supply Drug stocked on ward / readily available from pharmacy (including out of hours) Drug-highlighted as time-critical on electronic dug chart Nursing staff: Administration Nursing staff awareness of importance of time of administration Nursing staff awareness of patients on the ward on levodopa (handover)

  5. Procedures • Collected data over 2 week periods • Reviewed electronic drug charts of all patients on care of elderly wards • Recorded time of administration for all doses of levodopa • Interventions followed by further periods of data collection • Awareness – Meetings with senior sisters on each ward • Introduction of “get it on time” clocks • Recommendations circulated to nursing and medical staff

  6. Results Red = Doses given more than 30 minutes early / late Green = Doses given on time

  7. What difference has beenmade? • Modest improvement in proportion of levodopa doses being given on time • Increased awareness of importance of administering these medications on time

  8. Limitations • Compliance – Unclear how consistently the clocks are being used • The “difficult” patient • Unable to access electronic drug chart at the time of administration • Difficulty establishing the prescribed regimen at admission • Staffing levels and handover processes

  9. Next Steps • Involvement of pharmacy team • Supply of common preparations on the wards to avoid missed doses due to lack of availability • Levodopa prescriptions to be automatically marked time critical • Pharmacists to be able to mark levodopa prescriptions as time critical • Root cause analysis of doses consistently not given on time • Educational sessions to medical team • Alarms on each ward for dosing reminders • Expansion of use of “get it on time” clocks to all wards

  10. Team Members • T. Stoker – Project lead (Core medical trainee 1) • N. Al-Khudairi (Foundation year 1) • V. Russell (Foundation year 1) • J. Harvey (Consultant supervisor)

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