Establishing a framework for quality of inpatient care for Parkinson's disease: A study on inpatient medication administration
- PMID: 37495500
- DOI: 10.1016/j.parkreldis.2023.105491
Establishing a framework for quality of inpatient care for Parkinson's disease: A study on inpatient medication administration
Abstract
Background: The complexity of antiparkinsonian medications makes patients vulnerable to medication deviations. This study examines the frequency and outcomes of deviations between outpatient and inpatient medication administrations in patients with Parkinson's disease (PD).
Methods: We included hospital admissions of patients with PD during a 12-month period at the Cleveland Clinic Main and Fairview campuses. Outpatient regimens were compared with hospital medication administration records to establish rates of deviations in terms of levodopa equivalent daily dose (LEDD) difference, timing deviations/omissions of time-critical medications, substitution of levodopa compounds, and administration of antidopaminergic medications. Logistic regression analyses were used to investigate associations with length of stay (LOS), readmission rates, and mortality.
Results: The study included 492 patients with 725 admissions. Of those on time-critical medications, 43% had a LEDD deviation and 19% had levodopa formulation substitutions. Of the admission days with known outpatient timing regimens, 47% had an average deviation of more than 30 min and 22% had at least one missed levodopa dose. LOS was longer with each additional day of over-dose (4%), under-dose (14%), missed dose (21%), timing deviation (15%) and substitution (19%), (all p < 0.0001). Administration of antidopaminergic medications (9.9% of admissions) was associated with increased 30-day readmission/death (OR 1.85, p = 0.041), 90-day mortality (OR 2.2, p = 0.018), and LOS (7.6 vs. 3.8 days, p < 0.0001). LEDD underdose was associated with 30-day readmission/death (OR 1.78, p = 0.025) and 90-day mortality (OR 1.14, CI 1.05-1.24, p = 0.002).
Conclusions: Deviations between outpatient and hospital regimens, and administration of antidopaminergic medications, were associated with poor outcomes.
Keywords: Admission; Medication deviations; Parkinson's disease; Time-critical medications.
Copyright © 2023. Published by Elsevier Ltd.
Conflict of interest statement
Declaration of competing interest HHF has received research support from Biogen, Cerevel, Michael J. Fox Foundation, NIH/NINDS, Parkinson Study Group, Parkinson's Foundation, Roche but has no owner interest in any pharmaceutical company; has received honoraria from, Cleveland Clinic as a speaker in CME events; has received honoraria from Amneal, AbbVie, Cerevel, Neurocrine, Parkinson Study Group as a consultant. Elsevier as the Editor-In-Chief of Parkinsonism and Related Disorders Journal; has received royalty payments from Springer for serving as a book author/editor. BW serves as Section Head of Movement Disorders at the Cleveland Clinic. Over the years, he has received research grants from the NIH and Parkinson's Foundation. He has served as site investigator and/or co-investigator for clinical research studies sponsored by grants from Industry to Cleveland Clinic. Currently, he is the site PI for Neuroderm (Mitsubishi Tanabe Pharma), Discern (Great Lakes Neurotech/NIH R44), Tempo 2, and Tempo 3 studies (Cerevel Therapeutics) and a grant from the Parkinson's Foundation to improve the inpatient care of People with PD. He has served as a consultant or speaker for Medtronic, Boston Scientific, and Abbott for less than $5000 in the last year.
Comment in
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Practical proactive and preventative Parkinson's disease strategies for management in the hospital setting.Parkinsonism Relat Disord. 2023 Aug;113:105515. doi: 10.1016/j.parkreldis.2023.105515. Epub 2023 Jul 4. Parkinsonism Relat Disord. 2023. PMID: 37453869 No abstract available.
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