In this episode, I’ll discuss the importance of timely ordering and administration of antiparkinsonian medications for patients in the ED.
It is well established that maintaining the medication regimen for a patient with Parkinson’s disease is essential and that not doing so can have deleterious effects on morbidity and mortality rates.
But when a patient with such timely and frequent medication needs presents to the emergency department, it can be difficult to maintain such a regimen. Not only might a dose be missed while the presenting problem is worked up over the span of a few hours, but it if the patient is admitted to the hospital and spends time waiting for an inpatient bed to open up in the ED, even more time might pass before medication to treat Parkinson’s might be ordered and administered.
To better describe this potential problem a group of researchers published a retrospective chart review of 6 EDs in critical access hospitals in the journal Academic Emergency Medicine.
The authors describe what happened to 87 patients with Parkinson’s over the course of almost 300 patient encounters: The average length of stay in the ED for this cohort was just under 9 hours. Carbidopa-levodopa was administered only in one-third of the patient encounters. Only 4.3% of the time was it administered in a timely fashion, and 6.4% of the time was it administered within a 2-hour window.
On average the 1st administration was more than 6 hours after arrival to the ED and most of the administrations occurred 1 to 4 hrs (39.6%) or 4 to 8 hrs (26.4%) after the scheduled dose.
The authors concluded:
Less than one-third of older adults with PD received their home antiparkinsonian medication in the ED, and fewer than 10% received it on time. Targeted interventions to ensure timely medication administration are needed to prevent iatrogenic harm in this vulnerable population.
While these retrospective chart review based results are not necessarily generalizable to other institutions, it is easy to imagine in any ED that patients with Parkinson’s probably do not receive their medications in a timely fashion if they have been in the ED for 6 or more hours.
Replicating a retrospective chart review like this is a very realistic project for a pharmacy resident, and the pharmacy department would be in the perfect position to implement solutions to ensure timely administration of Parkinson’s medications in ED patients if similar results were found at other institutions.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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