Objective: To determine if a best practice advisory (BPA) reduced the orders and administration of contraindicated dopamine blocking agents (DBA) to hospitalized patients with Parkinson’s disease (PD) and related disorders.

Background: Patients with PD are more likely to require hospitalization and are at increased risk of complications. Contraindicated DBA contribute to worse outcomes in this population. BPAs have been proposed to prevent the administration of these medications. We present here the data on the impact of the BPA at our hospital.

Method: A BPA was created in January 2020 within the University of Rochester electronic medical record, which alerts the provider when a contraindicated DBA is ordered in patients with PD and related disorders. We compared a time period before (t1: 1/1/2019-1/1/2020) and after (t2: 1/8/2020-1/8/2021) the BPA implementation. Patients with PD and related disorders hospitalized at Strong Memorial or Highland Hospital were included. Problem List was used to identify the patients with any of the following diagnosis: Parkinsonism unspecified and PD (both ICD-10 G20), Dementia with Lewy Body (ICD-10 G31.83), Multiple System Atrophy (ICD-10 G90.3), Progressive Supranuclear Palsy (ICD-10 G23.1) and Corticobasal Degeneration (ICD-10 G31.85). Epic SliderDicer was used to obtain the number of orders and administrations of contraindicated DBA in both periods, and the number of BPA warnings triggered in t2.

Results: 306 patients with PD and related disorders were hospitalized in t1 and 273 in t2. During t1, 343 orders were placed (155 encounters, 127 patients) and 231 administrations were completed (62 encounters, 49 patients) for contraindicated DBA. During t2, 113 orders were placed (53 encounters, 48 patients) and 132 administrations were completed (29 encounters, 24 patients). The BPA was triggered 349 times (122 encounters, 101 patients) during t2.

Conclusion: The number of contraindicated DBA ordered and administered was 67% and 42% less after the BPA implementation, respectively. The number of times the BPA was triggered (349) was similar to the number of orders in t1 (343), supporting the role of BPA warnings in this reduction. These results suggest that BPA help prevent the administration of contraindicated DBA in hospitalized patients with PD and related disorders.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-best-practice-advisory-on-the-administration-of-contraindicated-medications-to-hospitalized-patients-with-parkinsons-disease-and-related-disorders/