Three out of four people with Parkinson's disease (PD) do not get their medications on time when hospitalized, according to a Parkinson's Foundation research study. As a result, 61 percent of those patients develop serious complications. In 2011, the Struthers Parkinson's Center, a Parkinson's Foundation Center of Excellence, decided to change these statistics.
In 2011, the center began distributing the foundation's free Aware in Care hospitalization kit to patients, but Medical Director Martha Nance, MD, and her Struthers team wanted to assess how big a problem it was for patients with PD to get medications on time within the center's affiliated hospital, Methodist Hospital.
"We decided to focus specifically on levodopa medication administration because we felt that was where our greatest impact could be," Dr. Nance said.
They began collecting and analyzing the hospital's computerized medical records, assessing the scheduled time hospital patients with PD were supposed to get their levodopa compared to the actual time they received it. The Struthers team realized that the problem was that hospital staff didn't realize how much of a difference timing made. The hospital staff cared about providing the best care, so the challenge was to explain why it was important and to give them tools to track their success. They developed what they internally called the "Medications on Time" program.
They began by increasing awareness among hospital staff about the importance of timely administration of medications to Parkinson's patients. The Struthers team then:
- Taught the hospitalists (doctor who cares for all hospitalized patients), key nursing units, and rehabilitation staff the importance of administering PD medications on time to patients with PD.
- Led Nursing Grand Rounds (a meeting held for all nurses on staff) with patients and caregivers as guest speakers.
- Initiated a monthly PD Medication Compliance Scorecard so each unit could keep track of their Medications on Time record.
- Launched the program in a second unit: the Emergency Room.
"Perhaps most importantly, and a bit of a surprise to us, during the program implementation was how inpatient pharmacy leaders and staff fully embraced the project and developed their own processes to help lead the effort," Dr. Nance said.
The program evolved, becoming more effective with time. The Struthers Medical Director, Clinic Supervisor and Research Director were all connecting with hospital physicians, inpatient nurse managers, nursing administration and the hospital information technology department. The pharmacy staff also participated by writing an article about the program and including it in their hospital-wide monthly newsletter. The word was out and new data was coming in.
The program triumphed when a custom-made alert within the hospital's computerized medical record system became standard practice for treating PD patients. The system alerted each nurse that was treating a patient with PD that levodopa needed to be administered within 15 minutes of the scheduled time. Certain levodopa medications were added to key hospital units. Pharmacy staff began reviewing the charts of all PD patients after patients were admitted to ensure that levodopa orders were correctly written.
Study results proved that the "Medications on Time" program significantly improved the administration of levodopa within 15 minutes of scheduled time. Before the study, 42 percent of Methodist Hospital patients with PD received their medications on time; after the program was implemented that number jumped to 66 percent. Two-thirds of doses are now given within 15 minutes of the scheduled times and 96 percent of levodopa doses are given within an hour of the scheduled time.
"The success of this project was due to efforts of outpatient and inpatient leaders and staff wanting to improve the hospital experience for people with Parkinson's and for their families," said Joan Gardner, RN, from the Struthers Center of Excellence. "With leader support, inpatient nurses could participate in education to improve understanding of the unique medication needs for levodopa, pharmacists receive a report and connect with patients and newly hired nurses receive PD-specific education in orientation."
Due to the program's impressive results, the Struthers team wanted to launch the program within the hospital's Emergency Room (ER) unit. A new workflow was introduced among ER admitting staff and a medical alert card was distributed to patients with PD. The card states that they have PD, must take medications frequently and on time and lists contraindicated medications (download the NPF medical alert card here).
The ER also saw incredible results. Before the "Medications on Time" program was implemented in the ER, 42 percent of patients received PD medication doses on time. A mere three months later, 81 percent of ER patients received their PD medications on time.
"Our patients return to clinic stating Methodist Hospital and ER staff had a good understanding of their needs and that they did not have to worry about not getting their pills on time," Joan said.
Dr. Nance and her team have plans for making the program even more effective. "We will continue to focus on maintaining this level of improvement, as well as further analyzing our data to understand why some doses are not given in a timely manner," Dr. Nance said. "We also hope to determine whether the timely administration of levodopa impacts other hospital outcomes such as falls, length of hospitalization, readmission rates and patient-family satisfaction."
Dr. Nance believes that this work can be replicated at other Parkinson's Foundation Centers of Excellence to further provide expert care to patients with Parkinson's.
"We are thrilled with the ongoing cooperative efforts between our Center team, pharmacy, IT, inpatient nursing and nursing administration — all of which whom critical to the success of the program," Dr. Nance said. "We are very proud of this effort, and our patients are happy, too."