Case report
Prescribing medications in Parkinson's disease (PD) patients during acute admissions to a District General Hospital

https://doi.org/10.1016/j.parkreldis.2006.11.006Get rights and content

Abstract

This is a short report illustrating the problems of the prescribing of anti-Parkinson's disease (PD) medication in patients with PD who are admitted acutely to hospital for any reason. There were a large number of complications as a result of inappropriate or lack of anti-PD drug administration and poor understanding amongst junior doctors and nursing staff. We suggest some changes that we have initiated in our hospital to try to improve the situation.

Introduction

In patients with Parknson's disease (PD) abrupt cessation of their anti-PD medication can have severe adverse effects [1], [2], [3]. Several of our PD patients became very unwell following emergency admission to hospital and their medications were inappropriately withheld for a variety of reasons. We looked into this and found very little published data on the extent of this problem. We decided to therefore carry out a retrospective audit of all patients with PD in our area who were admitted to the Princess Royal University Hospital (PRUH), a medium-sized District General Hospital in North Kent, over a year long period.

We examined the patient's condition, disability and treatments with specific reference to their anti-PD medications. We looked at whether medications were given, whether they were given on time, and if not what were the reasons for it. We also looked at any complaints that had been sent around these issues and analysed them as part of the audit tool. A questionnaire was given to all pre-registration House Officers (PRHOs) in the Trust to assess their understanding of anti-PD medications, reasons why medications may be omitted, alternative medications that may be given and any contraindicated medications. We also assessed whether PRHOs knew where to find more information around those issues and who to ask for support.

Section snippets

Data collection and analysis

We used case notes to examine all emergency admissions of patients that were followed up in our PD clinic. In addition, drug charts and nursing notes kept in A+E and the wards were also used. Patients were interviewed by telephone as well as their carers where-ever possible. The PRHOs were given individual questionnaires. The period between November 2004 and December 2005 was examined. During this time 35 PD patients were admitted to the hospital, 26 to the medical wards and 9 to the surgical

Results

  • Of the 35 patients admitted 26 (74%) of them had their medications stopped, omitted or prescribed inappropriately. Of those who had their medication stopped 16 (61%) developed clinically significant sequalae. This included 8 serious clinical incidents including a patient requiring transfer to the intensive care unit after their medications were abruptly stopped for a whole weekend.

  • Other sequelae included a lady collapsing and fracturing her hip after her Sinemet was stopped, patients becoming

Conclusion

This study demonstrates that the prescription and administration of medications to PD patients following their acute admission to hospital is poor and can result in potentially serious clinical complications. We have addressed the issue through a series of initiatives that we have set up in our Trust. A process of education to both nurses and junior doctors has been set up through specific teaching sessions as well as the publication of guidelines on how to care for PD patients on the hospital

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