How to Manage Parkinson’s Disease Patients in the Hospital Setting
By Christopher Cheney
Parkinson’s patients face three primary preventable complication risks in the hospital setting.
These risks are medication mismanagement such as nonadherence to time-sensitive medication administration; failure to ambulate Parkinson’s patients; and failure to screen for dysphasia, which is associated with aspiration and aspiration pneumonia.
CMOs and their care teams need to take steps to avoid preventable complication risks among Parkinson’s disease patients in the inpatient setting as part of their quality and patient care strategy, the lead author of a recently published journal article says.
The data on medication management missteps for Parkinson’s disease patients in the inpatient setting is “stunning,” according to the lead author of the recent journal article, Peter Pronovost, MD, PhD, chief quality and transformation officer at University Hospitals Cleveland Medical Center.
“Of the 300,000 patients with Parkinson’s disease admitted to hospitals each year, about 75% of them will have some medication mismanagement,” Pronovost says. “One-in-10 receive contraindicated medications that can make their symptoms worse.”
In addition to the recent article, which was published by The Joint Commission Journal on Quality and Patient Safety, hospital CMOs and their care teams can learn about managing hospitalized Parkinson’s patients at the Parkinson’s Foundation’s website.
Caring for Parkinson’s patients in the hospital setting
The first thing hospital care teams need to do to limit preventable complication risks for Parkinson’s patients is to identify them when they are admitted to the hospital, Pronovost explains.
“One of the main risks for patients living with Parkinson’s disease when they are hospitalized is most of them are not hospitalized for Parkinson’s disease,” Pronovost says. “Hospitals need to be able to identify people with Parkinson’s disease when they are admitted to the hospital. Most of our electronic medical records can do that.”
Hospital care teams should also use alerts in the electronic health record to make sure Parkinson’s patients do not get contraindicated medications, according to Pronovost.
“The electronic health record makes medication management much more feasible than having to do it manually,” Pronovost says. “It just requires collaboration between the information technology team and quality team to make sure they put alerts in place.”
The second thing hospital care teams can do is make sure that Parkinson’s patients can get their medications on time, which can be a window as small as 15 minutes at a particular time of day, according to Pronovost.
“The average hospital patient does not get medication on a tight schedule,” Pronovost says, “so there has to be a workflow for nursing, pharmacy, and physicians.”
The third thing hospital care teams can do is screen Parkinson’s disease patients for dysphasia, so they can identify who is at risk for aspiration, then put preventive strategies and protocols in place to make sure patients do not aspirate, Pronovost explains.
Finally, Parkinson’s patients in the hospital setting must be ambulated several times a day.
“We put a mobility program in place across all 23 of our hospitals because there are benefits from mobility for all patients,” Pronovost says. “Patients must be ambulated multiple times per day.”
Ambulating patients requires a culture of collaboration, where roles are clarified, Pronovost explains.
“In our hospital, we decided that patients who were more ambulatory would work with nurses and patients who were less ambulatory would work with physical therapy,” Pronovost says. “Then we monitor and measure who is getting ambulated.”
How hospital CMOs can help manage Parkinson’s patients
There are several ways hospital CMOs can ensure Parkinson’s patients receive safe and effective care in the inpatient setting.
“We know that Parkinson’s disease patients are at risk,” Pronovost says, “so CMOs need to make sure they have a way to identify patients and make sure they get the care protocols and programs that mitigate their risk.”
From a CMO leadership perspective, the best thing to do is start an interdisciplinary quality improvement team that includes staff such as neurologists, hospitalists, pharmacists, nurses, occupational therapists, and physical therapists, according to Pronovost.
“This team can look at the risks Parkinson’s patients have, the protocols that should be in place, who is going to perform the protocols, and what are the workflows,” Pronovost says.
“If there is no clarity about who is responsible for getting the medications exactly on time or ambulating,” Pronovost says, “patients are not going to get those therapies appropriately.”
Pronovost recommends that CMOs also make sure there are electronic health record standards and safeguards to ensure that patients with Parkinson’s disease get their medications on time.
“The same thing applies to mobility and dysphasia screens,” Pronovost says. “Our electronic health records can ensure safety and ensure patients who are at risk for harm are identified.”
Managing patients with Parkinson’s disease should be viewed as part of a hospital CMO’s responsibility for patient safety and quality, Pronovost explains.
“CMOs can assemble diverse teams to work together to do new work that has never been done before,” Pronovost says. “It requires the CMO to call the teams together with a clear commitment to zero harm and optimizing care for patients with Parkinson’s disease.”
Christopher Cheney is the CMO editor at HealthLeaders.