Making Hospitals Safer: How an Inpatient Program Can Reduce PD Medication Errors

A hospital stay can bring new risks for people with Parkinson’s disease (PD). People with Parkinson’s are more likely to be admitted to a hospital due to the complexity of PD and its symptoms. Additionally, during a hospital stay, they are also at high risk for medication errors, leading to longer hospitalization and a more difficult recovery. Not all hospital staff are trained in Parkinson’s care, which increases these risks.

A new study published in Annals of Neurology evaluated medication errors for people with Parkinson’s before and after a hospital introduced a dedicated inpatient Parkinson’s program.

What is a Parkinson’s inpatient program? 

A Parkinson’s inpatient program helps ensure hospital staff know how to care for people with Parkinson’s. The program supports inpatient teams by combining electronic health record alerts, improving access to a team of Parkinson’s experts, pharmacist support and staff education.

“The goal of a Parkinson’s inpatient program is to make sure a person’s Parkinson’s care needs are addressed while in the hospital, alongside the treatment needed for what brought them in. It may sound intuitive, but most hospitals do not have these programs in place. That’s the gap the Parkinson’s Foundation and this study are working to address,” said Patricia Clark, Nurse Practitioner at the Cleveland Clinic Center for Neurological Restoration, who supports people with Parkinson’s in the hospital. 

This study, conducted by Cleveland Clinic with funding from the Parkinson's Foundation, examined medication errors and other outcomes before and after implementing an inpatient PD program. The researchers studied three main types of medication errors:

1. Administering medications that can worsen PD symptoms or cause harm (contraindicated medications) 
2. Changes in the patient’s regular Parkinson’s medication dose  
3. Changes in the patient’s regular Parkinson’s medication timing 

For the study, the Cleveland Clinic Main and Regional (Fairview) campuses in Northeast Ohio implemented a Parkinson’s inpatient program. Hospitalizations of people with PD were tracked before and after the program launched. As part of the program, staff were trained in PD care, and the electronic health record (EHR) was modified to alert hospital staff of PD interaction alerts for contraindicated medications. The study compared information from 2,822 hospital days spread over a year before the program launch versus 1,390 hospital days spread over 6 months after launch. 

Study Results 

• Fewer medication timing errors: After the program, Levodopa was given more than 30 minutes earlier or later than scheduled on 51% of hospital days, compared with 72% before the program. Timing errors occurred in 32% of admissions, compared with 46% before the program.
• Fewer missed doses: After the program, missed doses were significantly reduced (17% compared to 22% before the program).
• Levodopa daily dose deviations: The number of days with Levodopa dosage changes, as well as the average dose deviations per day and per admission, decreased after the program. 38% of patients had a Levodopa deviation, significantly lower than the 43% before the program. 
• Discharge to home improved from 55% of admissions before the program to 61% after. 
• The rate of discharge to non-home settings decreased. 
• No change in other outcomes: the program did not significantly change length of hospital stay, 30-day readmission, 30-day or 90-day mortality.

When it came to contraindicated medications (unsafe medications for people with PD), 9% of PD patients received contraindicated medications after the program, which is not significantly different from before the program (12%). However, those who received contraindicated medications received fewer doses compared to before the program. Additionally, of the eight contraindicated drugs administered before the program, three are no longer administered: aripiprazole, risperidone and paliperidone. 

Learn more about contraindicated medications

Making Hospitals Safer for people with Parkinson’s 

This study has numerous big picture takeaways for the PD and hospital health care communities. This is the first study to address multiple medication error types simultaneously through combined Electronic Health Record (EHR) changes, staff education and a dedicated inpatient program. 

Additionally, the program partnered with First Databank, a global leader in clinical and descriptive medication information used by hospitals and health systems, to reclassify contraindicated medications to help other institutions receive and act on the same warning. Another strength is that the program positioned a PD-experienced team on the hospital floor, working closely with patients and health care personnel. This led to timely, personalized care and caught care issues faster.

“The Parkinson’s Foundation is working with hospitals across the U.S. to eliminate preventable harm and promote more reliable care for people with Parkinson’s when hospitalized. Supporting high-impact studies like this one gives other health systems the tactics to implement in real-world settings, starting now,” said Sneha Mantri, MD, Parkinson’s Foundation Chief Medical Officer.

Through its Hospital Care Initiative, the Parkinson's Foundation is leading the national effort to improve hospital care for people with Parkinson’s through systemic changes in policy, technology, culture and education.

Explore our hospital safety resources for people with Parkinson’s and care partners and for professionals.