Q&A with Diane M. Ellis, Parkinson’s Expert and Nurse

dianeDiane M. Ellis, MSN, RN, CCRN is a clinical assistant professor at Villanova University M. Louise Fitzpatrick College of Nursing and Edmond J. Safra Nurse Faculty Scholar. As a recipient of the first Parkinson’s Foundation Nurse Faculty Award, she received grant funding to launch a project to help make life better for people with Parkinson’s disease (PD). 

What are the highlights of your Parkinson’s Foundation Nurse Faculty Award project?

Diane: The purpose of this study: An Intraprofessional Mock Code: Nurse Anesthesia and Baccalaureate Nursing Students – Parkinson’s Disease Patient Missed/Omitted/Delayed (MOD) Medication Simulation Case Study was to increase awareness and educate undergraduate nursing and graduate nurse anesthesia students about the importance of timely administration of Parkinson’s medication. missed/omitted/delayed PD medications during care transitions. We studied the intraprofessional collaboration between the students , communication and comfortability between the students during a simulated emergency code situation of a an unfolding mock code simulated hospitalized patient with PD.

Because omitted medications compromise patient safety, quality improvement strategies that focused on safe and timely medication administration and medication reconciliation during care transitions were undertaken. Pre-test/Post-test results were compared post mock code simulation and debriefing from the participating students .

What were the study findings?

Diane: Overall, more than half of the undergraduate senior nursing students who participated in the study were unable to correlate a patient’s declining health as missed doses of PD medication until the second half of the case, when the connection became apparent. By the end of the study, students showed a:

  • 53.6% increase in knowledge regarding the importance of PD medication timing.
  • 54.3 % increase in knowledge regarding best practices to prevent missed or omitted PD medications.
  • 71.3 % increase in knowledge regarding side effects and complications of missed or omitted PD medications.
  • 46.8% increase in knowledge regarding priority nursing care practices for patients with PD.

Among faculty who participated, study results also showed a:

  • 71.4% increase in faculty knowledge regarding the importance of PD medication timing
  • 57.1% increase in faculty knowledge regarding best practices to prevent missed or omitted PD medications
  • 85.7% increase in faculty knowledge regarding side effects and complications of missed or omitted PD medications
  • 57% increase in faculty knowledge regarding priority nursing care practices for patients with PD.

What did it mean to you to receive the Parkinson’s Foundation Nurse Faculty Award?

Diane: My team and I were very happy to receive funding to conduct this study as it gave us the ability to pay for essential personnel to assist in this study and to support students and faculty in the dissemination of the results of this study.

How did the study simulation help educate the nursing students involved?

Diane: I believe study results speak for themselves regarding how the students gained pertinent and lifelong knowledge in PD care. This simulation was the perfect environment for high risk low volume patients. These students previously received a two-hour PD lecture, but still were unable to answer the most basic PD questions related to the care of patients with PD and their medication administration.

Due to the nature of the simulation, the students reacted and participated as if this were a hospital setting. Their pulses were elevated, faces were flushed and they were speaking quickly, as if they were in a real world situation. Even nurses and faculty who had been practicing for years were not aware of the basic fact that a person with PD cannot miss their medications. This was an unforgettable experience for faculty, students and nurses, who will now always remember that a PD medication can never be withheld. Without this experience they would never have learned this lifesaving information as it relates to people living with PD.

How did your experience as an Edmond J. Safra Visiting Nurse Faculty Scholar influence this project?

Diane: It is because I am a Safra Scholar that I even knew about this funding and started to do Parkinson’s research. My previous publications with the Safra program allowed me to build the research to where it is today.  

How did this study encourage intraprofessional team care?

Diane: This study promoted intraprofessional communication, collaboration and comfortability by having undergraduate students and experienced health professionals working together in a simulation safe environment. 

Students in this environment were learning and performing tasks that were new to them, but doing so with trained professionals to support and provide feedback. Undergraduate nursing students could listen and learn from experienced nurse anesthesia graduate students. This simulation gave these students an increased comfort level to perform more efficiently and effectively in an actual life-threatening situation within a hospital.

What are some of the biggest challenges a person with Parkinson’s can experience in the hospital?

Diane: Parkinson’s patients are more likely to be hospitalized with complications and with decline during hospitalization. Missing medications occurs frequently in hospitalized Parkinson’s patients with increase length of stays (Martinez-Ramirez et al., 2015). Parkinson's medication errors, including missed, omitted, and delayed medications are risk factors for protracted hospital stays (Lertxundi et al 2018). Three-fourths of patients hospitalized with PD do not receive medications on time or are completely missed (Grissinger, 2018).

References

DiBartolo, M. (2017). Enhancing care for hospitalized patients with Parkinson's Disease: Development of a formal educational program for nursing staff. Journal of Gerontological Nursing, 43(5), 18-22. doi:10.3928/00989134-20170223-02

Chambers, D., Sebastian, J., & Ahearn, D. (2017). Parkinson’s Disease. BJA Education 17(4), 145-149. doi:10.1093/bjaed/mkw050

Grissinger, M. (2018). Delayed administration and contraindicated drugs place hospitalized Parkinson’s Disease patients at risk. P&T 43(1), 10-11.

Gültekin, M. (2017). Medication errors increase risk of death in patients with Parkinson’s Disease. Turkish Journal of Neurology 23, 153-154. doi:10.4274/tnd.17003

Lertxundi, U., Isla, A., Ángeles Solinís, M., Domingo-Echaburu, S., Hernandez, R., Peral-Aguirregoitia, J., … García-Moncó, J. C. (2016). Medication errors in Parkinson’s Disease inpatients in the Basque Country. Parkinsonism and Related Disorders.

Lertxundi, U., Arantxa, I., Solinís, M. A., Echaburu, S. D., Hernandez, R., Peral-Aguirregoitia, J., García-Moncó, J. C. (2017). Medication errors in Parkinson's disease inpatients in the Basque Country. Parkinsonism & Related Disorders, 36, 57-62. doi:10.1016/j.parkreldis.2016.12.028

Mahajan, A., Balakrishnan, P., Patel, A., Konstantinidis, I., Nistal, D., Annapureddy, N., Sidiropoulos, C. (2016). Epidemiology of inpatient stay in Parkinson’s disease in the United States: Insights from the Nationwide Inpatient Sample. Journal of Clinical Neuroscience, 31, 162-165. doi:10.1016/j.jocn.2016.03.005

Martinez-Ramirez, D., Giugni, J. C., Little, C. S., Chapman, J. P., Ahmed, B., Monari, E.,    Okun, M. S. (2015). Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients. PLoS ONE, 10(4), e0124356. doi:10.1371/journal.pone.0124356.

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