Objective: To characterize the incidence and severity of outcomes for PD patients admitted to the hospital who miss doses of their medication.

Background: PD is a progressive neurodegenerative disorder that leads to significant morbidity with adverse effects on quality of life and increased utilization of inpatient services. In a survey of 684 PD patients 26% had received incorrect anti-Parkinson’s medication and 66% of missed doses were due to PD patients having been placed on NPO status. There is limited literature pertaining to the major reasons patients with PD are placed on NPO status during hospitalization.

Method: Determined as not human subjects research per IRB. A chart review of deidentified PD patient admissions was queried from the EHR of a large safety net hospital in Boston, MA from January 2014 to October 2019. A total of 834 patients were screened, and 280 patients met predetermined inclusion criteria, yielding a total of 425 unique admissions: 202 NPO admissions and 223 non-NPO admission respectively. Demographic and clinical data were extracted from each subject’s chart. Reasons for hospitalization and for NPO status were classified. Severity of PD was based on aggregate medication classes prescribed prior to admission. A composite score of adverse events were tallied among groups. Discharge destination was classified as either home or not home.

Results: NPO patients were about half as likely to get discharged at any time OR = 0.49 (95% CI: 0.38, 0.62), p < 0.0001. Among the NPO cohort, the mean number of doses of PD medications missed was 3.0 (SD = 5.8, median 2). A total of 19 patients suffered adverse events, including 10 mortalities.  Among the non-NPO cohort, there were no adverse events or mortalities. NPO patients are slightly less likely to be discharged home OR = 0.84 (95% CI: 0.52, 1.4) p = 0.47 and slightly more likely to be readmitted within 30 days OR = 1.4 (95% CI: 0.60, 3.2), p = 0.44. There was no significant difference in length of stay. Composite endpoint of adverse events was not met. NPO patients are slightly less likely to be discharged home OR = 0.84 (95% CI: 0.52, 1.4) p = 0.47 and slightly more likely to be readmitted within 30 days OR = 1.4 (95% CI: 0.60, 3.2), p = 0.44.

Conclusion: Admitted PD patients with NPO status are more likely to miss medication doses and are half as likely to be discharged home. This data establishes a need for supplying PD medications that can be administered by alternative routes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/review-of-npo-status-on-admitted-pd-patient-outcomes/