Parkinson’s disease is a progressive disorder affecting the nervous system. Parkinson’s medications play a crucial role in controlling symptoms, but the medications are time-sensitive; any delay in administering them can negatively impact a patient’s mobility.
This study set out to raise awareness among the clinical staff at Encompass Health Rehabilitation Hospital of Treasure Coast through educational in-services and visual cues to help ensure the prompt administration of Parkinson’s mediations. Staff is working together to avoid the negative effects late medication can have on patients with Parkinson’s.
The goal of this collaborative clinical practice improvement project was to raise awareness of the importance of prompt medication administration in this patient population, so they could make the most of their time in therapy in the inpatient rehabilitation setting.
With the implementation of educational in-services, daily huddle discussions and visual cues, we were able to see significant improvements in the prompt administration of Parkinson’s medications for our patients.
The On-Off Effect
Patients with Parkinson’s can experience the “on-off” effect. During the “on” phase the medication is working to decrease their symptoms; during the “off” phase, the medication begins to wear off and symptoms increase.
As the “off” phase begins the patient’s symptoms are poorly controlled, which affects their ability to take part in therapies. It is important that their medications are given on time every time to avoid prolonged “off” effects and provide them with the opportunity to take part in therapy.
In-Services
After attending a seminar on Parkinson’s, Morgan Rickett, an occupational therapist at Encompass Health Treasure Coast, created a Parkinson’s presentation highlighting the importance of timely medication administration and held In-services for all staff.
Huddles/Discussions
In addition, pharmacy department now meets with the patient and/or caregiver to confirm their Parkinson’s medications and administration times. The pharmacy’s goal is to meet with the patient and/or caregiver on the day of admission to determine a patient’s preferred medication administration times. Medication administration times are then ordered specific to the patient’s preference.
Visual Cues
Patients with Parkinson’s disease either as a primary or secondary diagnosis at our hospital now have a purple flower attached to their wheelchair and on a board in their rooms. The flower has the patient’s Parkinson’s medication times on it to decrease medication delays and therefore increase rehabilitation potential for these patients. The flower serves as a visual cue to staff that the patient takes Parkinson’s medications, and timing is crucial.
Parkinson's Medication Study
Download the StudyThe Results
Our goal is to deliver Parkinson’s medications “on time every time.”Ongoing chart audits are being performed to track medication administration times. Further education is being provided for staff that do not meet the goal. We rolled this initiative out in October of 2023. Chart audits for September 2023 showed a 62.8% on time rate before this initiative started. Since that time, the percentage has increased to an 88.9% on time rate for March 2024.
Education and awareness have been the driving force behind our improvements. The educational in-services, daily huddle discussions and the visual cues brought forth marked improvements in the prompt administration of Parkinson’s medications for our patients. The results of this project support the need for targeted clinical education as a tool to effectively manage Parkinson’s medications and avoid unnecessary negative outcomes occurring due to delays or omissions. A well-developed Parkinson’s medication education program may improve knowledge deficits in clinical practice.
STUDY BY:
Ann Marie Cooney MSN RN CRRN NE-BC, Lisa Kuh MSN RN CRRN, Morgan Rickett OT, Michele Warner RN​
Encompass Health Rehabilitation Hospital of Treasure Coast
References
Azmi, H., Ruzicka, F., Cocoziello, L., Pederson, J., Clar, E., Rocco, A., & Thomas, F. (2022, September). Improving timely administration of PD meds in the hospital by using” custom” schedules. In MOVEMENT DISORDERS (Vol. 37, pp. S46-S47).
Corrado, J., Jackson, O., Baxandall, D., Robson, J., Duggan-Carter, P., Throssell, J., … & Cracknell, A. (2020). Get Parkinson’s medications on time: the Leeds QI project. Age and Ageing, 49(5), 865-872.
Ortiz, M.S. (2020), “On time – every time” A new strategy for dosing levodopa in hospital. J Pharm Pract Res, 50: 339-344. https://doi.org/10.1002/jppr.1641
Yu, J. R. T., Sonneborn, C., Hogue, O., Ghosh, D., Brooks, A., Liao, J., … & Walter, B. L. (2023). Establishing a framework for quality of inpatient care for Parkinson’s disease: A study on inpatient medication administration. Parkinsonism & related disorders, 113, 105491.
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