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Yuksel JM, Ulen KR, Brenner JM, Brangman SA, Noviasky J. Improved Outcomes When Home-Dose Carbidopa-Levodopa Is Continued in the Geriatric Emergency Department in Patients With Parkinson's Disease. Sr Care Pharm 2024; 39:242-248. [PMID: 38937894 DOI: 10.4140/tcp.n.2024.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Parkinson's disease (PD) is a debilitating condition that affects 1.8% of people 65 years of age and older. Patients with PD often require hospitalization and are frequently admitted through the emergency department (ED). Notably, their hospital durations tend to be lengthier compared with patients without PD. The primary outcome of this research was to compare the length of stay (LOS) of patients who received carbidopa-levodopa (CL) in the ED with those who did not. Secondary outcomes included 30-day-readmission rates and administration of injectable for agitation. In addition, the percentage of patients receiving CL before and after an information management technology (IMT) alert implementation was compared in a sub-analysis. Patients that received CL during their inpatient stay were identified by a database report in this retrospective study. Patients were excluded if they were not admitted through the ED, younger than 65 years of age, or admitted to the intensive care unit after the ED. There was a total of 266 in the control group and 217 patients in the intervention group. The intervention group had a significantly shorter LOS than the control group (3.29 vs 5.37 days; P = 0.002), significantly less frequent 30-day readmissions (P = 0.032), and used fewer injectables for agitation (P = 0.035). The sub-analysis of the IMT alert revealed that prior to the alert's implementation, 28.5% of patients received CL in the ED; whereas post-alert, this percentage increased to 91.4% (P < 0.001). The results of this study found that the group of PD patients who received CL in the ED had shorter LOS, lower 30-day readmissions, and used less injectables for agitation compared with the group that did not receive CL in the ED. This improvement is possibly due to continuity of CL supply considering its short half-life and clinical importance for PD.
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Affiliation(s)
- Jaylan M Yuksel
- 1 Upstate Community Hospital, 4900 Broad Road, Syracuse, New York
| | - Kelly R Ulen
- 1 Upstate Community Hospital, 4900 Broad Road, Syracuse, New York
| | - Jay M Brenner
- 1 Upstate Community Hospital, 4900 Broad Road, Syracuse, New York
| | - Sharon A Brangman
- 2 Upstate University Hospital, 750 East Adam Street, Syracuse, New York
| | - John Noviasky
- 1 Upstate Community Hospital, 4900 Broad Road, Syracuse, New York
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Shurer J, Golden SLS, Mihas P, Browner N. More than medications: a patient-centered assessment of Parkinson's disease care needs during hospitalization. Front Aging Neurosci 2023; 15:1255428. [PMID: 37842122 PMCID: PMC10569176 DOI: 10.3389/fnagi.2023.1255428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background Parkinson's disease (PD) increases the risk of hospitalization and complications while in the hospital. Patient-centered care emphasizes active participation of patients in decision-making and has been found to improve satisfaction with care. Engaging in discussion and capturing hospitalization experience of a person with PD (PwP) and their family care partner (CP) is a critical step toward the development of quality improvement initiatives tailored to the unique hospitalization needs of PD population. Objectives This qualitative study aimed to identify the challenges and opportunities for PD patient-centered care in hospital setting. Methods Focus groups were held with PwPs and CPs to capture first-hand perspectives and generate consensus themes on PD care during hospitalization. A semi-structured guide for focus group discussions included questions about inpatient experiences and interactions with the health system and the clinical team. The data were analyzed using inductive thematic analysis. Results A total of 12 PwPs and 13 CPs participated in seven focus groups. Participants were 52% female and 28% non-white; 84% discussed unplanned hospitalizations. This paper focuses on two specific categories that emerged from the data analysis. The first category explored the impact of PD diagnosis on the hospital experience, specifically during planned and unplanned hospitalizations. The second category delves into the unique needs of PwPs and CPs during hospitalization, which included the importance of proper PD medication management, the need for improved hospital ambulation protocols, and the creation of disability informed hospital environment specific for PD. Conclusion PD diagnosis impacts the care experience, regardless of the reason for hospitalization. While provision of PD medications was a challenge during hospitalization, participants also desired flexibility in ambulation protocols and an environment that accommodated their disability. These findings highlight the importance of integrating the perspectives of PwPs and CPs when targeting patient-centered interventions to improve hospital experiences and outcomes.
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Affiliation(s)
| | | | - Paul Mihas
- Odum Institute for Research in Social Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nina Browner
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Turnbull K, Murphy K. Importance of timely administration of dopaminergic medications to improve Parkinson's patients' clinical outcomes. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:726-729. [PMID: 37596083 DOI: 10.12968/bjon.2023.32.15.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
This article explores the challenges posed when ensuring the effective management of patients with Parkinson's in the secondary care setting. The evidence base around the appropriate timing and administration of medications is explored and highlights key themes in the literature to support best practice and raise clinical awareness. Failure to follow prescribed treatments for patients with Parkinson's can have significant implications for both patients and nursing care.
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Affiliation(s)
- Katie Turnbull
- Staff Nurse, Northumbria Healthcare NHS Foundation Trust
| | - Kevin Murphy
- Assistant Professor in Adult Nursing, Northumbria University, Newcastle upon Tyne
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Hollern DA, Shah NV, Moattari CR, Lavian JD, Akil S, Beyer GA, Najjar S, Desai R, Zuchelli DM, Schroeder GD, Passias PG, Hilibrand AS, Vaccaro AR, Schwab FJ, Lafage V, Paulino CB, Diebo BG. Outcomes of Patients With Parkinson Disease Undergoing Cervical Spine Surgery for Radiculopathy and Myelopathy With Minimum 2-Year Follow-up. Clin Spine Surg 2021; 34:E432-E438. [PMID: 34292198 DOI: 10.1097/bsd.0000000000001233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective cohort analysis. OBJECTIVE To identify the impact of Parkinson disease (PD) on 2-year postoperative outcomes following cervical spine surgery (CSS). SUMMARY OF BACKGROUND DATA (PD) patients are prone to spine malalignment and surgical interventions, yet little is known regarding outcomes of CSS among PD patients. MATERIALS AND METHODS All patients from the Statewide Planning and Research Cooperative System with cervical radiculopathy or myelopathy who underwent CSS were included; among these, those with PD were identified. PD and non-PD patients (n=64 each) were 1:1 propensity score-matched by age, sex, race, surgical approach, and Deyo-Charlson Comorbidity Index (DCCI). Demographics, hospital-related parameters, and adverse postoperative outcomes were compared between cohorts. Logistic regression identified predictive factors for outcomes. RESULTS Overall, patient demographics were comparable between cohorts, except that DCCI was higher in PD patients (1.28 vs. 0.67, P=0.028). PD patients had lengthier mean hospital stays than non-PD patients (6.4 vs. 4.1 d, P=0.046). PD patients also incurred comparable total hospital expenses ($69,565 vs. $57,388, P=0.248). Individual medical complication rates were comparable between cohorts; though PD patients had higher rates of postoperative altered mental status (4.7% vs. 0%, P=0.08) and acute renal failure (10.9% vs. 3.1%, P=0.084), these differences were not significant. Yet, PD patients experienced higher rates of overall medical complications (35.9% vs. 18.8%, P=0.029). PD patients had comparable rates of individual and overall surgical complications. The PD cohort underwent higher reoperation rates (15.6% vs. 7.8%, P=0.169) compared with non-PD patients, though this difference was not significant. Of note, PD was not a significant predictor of overall 2-year complications (odds ratio=1.57, P=0.268) or reoperations (odds ratio=2.03, P=0.251). CONCLUSION Overall medical complication rates were higher in patients with PD, while individual medical complications as well as surgical complication and reoperation rates after elective CSS were similar in patients with and without PD, though PD patients required longer hospital stays. Importantly, a baseline diagnosis of PD was not significantly associated with adverse two-year medical and surgical complications. This data may improve counseling and risk-stratification for PD patients before CSS. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Douglas A Hollern
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Cameron R Moattari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Joshua D Lavian
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Samuel Akil
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - George A Beyer
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Salem Najjar
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Rohan Desai
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Daniel M Zuchelli
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | - Alan S Hilibrand
- Rothman Orthopaedic Institute
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, New York, NY
| | | | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
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Lertxundi Etxebarria U, Palacios-Zabalza I, Ibarrondo I, Domingo-Echaburu S, Hernandez R, Isla A, Solinis M. Pharmacotherapeutic management of Parkinson's disease inpatients: how about asking hospital pharmacists? Eur J Hosp Pharm 2020; 28:e140-e145. [PMID: 33355236 DOI: 10.1136/ejhpharm-2020-002461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is considered to be the fastest growing neurological disorder in the world. Patients with PD are hospitalised more frequently, have longer admissions and experience more complications during hospitalisation than age-matched control groups. The incorrect timing of levodopa administration and prescription of contraindicated antidopaminergic drugs are the most important risk factors for motor function deterioration during hospital admission, and have been associated with longer hospital stays and even increased mortality. Despite their crucial role in pharmacotherapy, little attention has been paid to the perspective of hospital pharmacists. The objective of this study was to identify key issues in the pharmacotherapeutic management of inpatients with PD by the implementation of a national Spanish survey specifically designed to analyse the perspective of hospital pharmacists. METHODS An internet-based questionnaire covering the following areas was designed: hospital and participant characteristics, drug formulary, medication compliance and reconciliation, protocols and contraindicated drugs and areas for improvement. RESULTS A total of 76 pharmacists from 59 hospitals answered the survey. Some weaknesses were identified in the availability of drugs: (1) pharmacy services closed at certain times (86.4%); (2) low variety of antiparkinsonian drugs (18.4% store >21 different drugs); (3) delay in antiparkinsonian drug administration if unavailable (>12 hours in 39.5% of cases); (4) lack of flexibility in administration times; (5) low availability of transdermal rotigotine and subcutaneous apomorphine (<50%). The participants ranked highly the designing of specific protocols for patients with PD and implementation of concrete actions to optimise PD inpatient pharmacotherapy. CONCLUSIONS The participants detected some improvement opportunities and proposed realistic and applicable recommendations and strategies aiming to enhance the safety of patients with PD. Protocols for antiparkinsonian drug interchange, administration timing and nil by mouth status, medication reconciliation, and handling nausea/vomiting or psychotic symptoms are considered the main improvement areas.
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Affiliation(s)
- Unax Lertxundi Etxebarria
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain
| | - Itziar Palacios-Zabalza
- Biocruces Bizkaia Health Research Institute, Pharmacotherapy: Effective, safe and rational use of drugs research group, Osakidetza, Bizkaia, Spain.,Pharmacy Service, Barrualde Integrated Health Organization, Bizkaia, Spain
| | - Itziar Ibarrondo
- Biocruces Bizkaia Health Research Institute, Pharmacotherapy: Effective, safe and rational use of drugs research group, Osakidetza, Bizkaia, Spain.,Pharmacy Service, Barrualde Integrated Health Organization, Bizkaia, Spain
| | | | - Rafael Hernandez
- Internal Medicine Service, Araba Mental Health Network, Vitoria-Gasteiz, Spain
| | - Arantxa Isla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country (UPV/EHU), Paseo de la Universidad, Vitoria-Gasteiz, Spain
| | - Marian Solinis
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country (UPV/EHU), Paseo de la Universidad, Vitoria-Gasteiz, Spain
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6
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Challenges in ICU Care. Crit Care Nurs Q 2020; 43:205-215. [DOI: 10.1097/cnq.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Furnish C, Wagner S, Dangler A, Schwarz K, Trujillo T, Stolpman N, May S. Evaluation of Medication Administration Timing-Are We Meeting Our Goals? J Pharm Pract 2020; 34:750-754. [PMID: 32070193 DOI: 10.1177/0897190020905456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Per the Centers for Medicare and Medicaid Services (CMS) Code of Federal Regulations (CFR) 482.23(c) regarding medication administration, hospital policies and procedures must identify time-critical scheduled medications which must be administered within 30 minutes either before or after the scheduled dosing time, for a total administration window of 1 hour. OBJECTIVE The general objective of this analysis was to determine whether there was a difference in meeting medication administration goals when comparing time-critical to non-time-critical scheduled medication administration in both intensive care units (ICUs) and general medical floors at a large, academic medical center. METHODS Data were collected in 6 inpatient nursing units (3 general medical units and 3 ICUs) during the month of June 2017. Electronic medical record charge data for medications were used to evaluate timeliness of medication administration. RESULTS In total, 69,794 medication administrations were evaluated. Of 389 administrations of time-critical scheduled medications, 268 (69%) were administered on time. Of 69,405 administrations of non-time-critical scheduled medications, 58,099 (84%) were administered on time (P < 0.001). ICUs had a higher percentage of on-time administrations than general medical units (89% vs 77%, P < 0.001), and nurses had a higher percentage of on-time administrations than respiratory therapists (84% vs 63%, P < 0.001). CONCLUSIONS Non-time-critical scheduled medications were more commonly administered on time compared with time-critical scheduled medications. Staff education and optimizations to the electronic health record (EHR) are interventions that may improve administration of time-critical scheduled medications.
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Affiliation(s)
- Craig Furnish
- University of Colorado Hospital, Aurora, CO, USA.,University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Samantha Wagner
- University of Colorado Hospital, Aurora, CO, USA.,University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | | | - Kerry Schwarz
- University of Colorado Hospital, Aurora, CO, USA.,University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Toby Trujillo
- University of Colorado Hospital, Aurora, CO, USA.,University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | | | - Sondra May
- University of Colorado Hospital, Aurora, CO, USA
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