Objective: To report baseline hospitalization outcomes in PD and the development of a comprehensive program for quality improvement.

Background: Hospitalization is common in PD and associated with significant morbidity and mortality.  The Parkinson Foundation has delineated four target areas to improve safety. These include reducing contraindicated medications, improving on-time medication administration, early mobilization, and swallow screens.

Method: We explored baseline hospital outcomes over one year.  We assembled a multidisciplinary team of experts, engaging nursing administration, pharmacy, rehabilitative therapy, Parkinson center coordinator, movement disorder neurology, medical informatics, and hospital outcomes professionals.  The team met frequently to sequentially implement safety protocols.

Results: We tracked outcomes encompassing 653 encounters.  We present baseline data for the following safety outcomes: falls (0.6%), contraindicated medications (23%), completed swallow screens (4.5%), length of stay (5 days), mortality (5.7%) and mobilization parameters. The team met regularly (and continues) to advance specific goals in practical, feasible ways.  We strategized how to identify PD patients on non-neurology services, which encompass the majority of admissions.  We implemented a pop-up upon order of any potential PD medication as a surrogate marker for possible PD.  The pop-up asks whether the patient has parkinsonism, and an easy click adds it to the problem list. This allows for triggering PD-specific protocols.  We established customized medication ordering (dose/time) and created a list of contraindicated medications that trigger best practice advisory safety checks (pop-ups in the EMR). Our rehabilitative team defined safe and meaningful mobilization goals and implemented tracking.  Our staged, targeted intervention includes required training for all inpatient nurses (brief high yield powerpoint), further education for high-impact units, pathways to suggest considering swallow evaluation, and assessing impact of EMR-driven safety alerts on our baseline outcomes.

Conclusion: Our one-year analysis of baseline safety outcomes is being used to drive systematic quality improvement measures to improve hospitalization safety for people with PD. This project aims to improve safety in our hospital system, and to share successful measures with other centers.

References: Pronovost P, Azmi H, Okun MS, Walter B, Brooks A, Rosenfeld S. Protecting Parkinson’s Patients: Hospital Care Standards to Avoid Preventable Harm. Jt Comm J Qual Patient Saf. 2024 Dec;50(12):890-892. doi: 10.1016/j.jcjq.2024.08.004. Epub 2024 Nov 18. PMID: 39562228.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hospitalization-safety-in-parkinsons-disease-pd-baseline-outcomes-tracked-over-1-year-and-a-multi-disciplinary-program-to-improve-care/