Objective: To explore whether implementing dedicated cohort warding, specialist nursing and acute admission pre-alert improves the medication management of patients with Parkinson’s (PwP).

Background: Previous studies have shown significant errors in medication delivery for PwP and extended Length of Stay (LoS) compared to control [1]. Other specialities have integrated cohort wards to focus specialist care with good effect and have pre-alert for incoming admissions (e.g. Stroke). We endeavour to see the effect of similar changes would be to PwP.
Consequently, the following changes were made:
Cohort ward designated for medically appropriate PwP
Daily outreach ward round
Employment of Nurse specialists
Pre-alert of PwP in acute and elective admissions

Method: Prospective data was collected at one district general hospital in the United Kingdom. A review of medical notes and prescription charts were undertaken of 31 consecutive Parkinson’s admissions at three separate time points (2010, 2014 & 2019). Patients were asked to complete a feedback questionnaire during their admission. Electronic records were reviewed for re-admission within 90 days.

Results: There was a 50% reduction in LoS from 24 to 14 days from 2010 – 2019. 90 day Re-admission rates remained static at 13% (n = 4) at each time interval.
Accuracy of medication timing increased from 73% to 97%. Medication reconciliation within 24 hours increased from 40% to 75%. In 2010 60% of patients experienced a delay in first dose of Parkinson’s medication, reduced to 9.5% in 2019. 64% of patients were assessed to self-medicate – an increase of 34%.
An increase in patient satisfaction was seen with 94% satisfied with their Parkinson’s management in 2019.

Conclusion: Despite a significant increase in Parkinson’s prevalence and admissions over the past decade we have shown that a system of early specialist nurse involvement, prompt medicine reconciliation and cohort ward design can lead to an appreciable decrease in medication errors and delay. We have also seen patient LoS halve, helping create extra bed capacity. Reassuringly, these changes have shown a consistent increase in patient satisfaction to 94%.
Readmission rates were unaffected by our changes – the cause of this is beyond the scope of this study but may be due to further variables in primary care or discharge planning.

References: 1.Parkinson’s UK.(2006) GET IT ON TIME- the case for improving medication management for Parkinson’s. Available from https://www.parkinsons.org.uk. (Accessed January 2020)

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