Objective: To describe the development of nursing roles, policies, and safety processes supporting implementation of foslevodopa/foscarbidopa infusion therapy for advanced Parkinson’s disease in a tertiary movement disorder centre in the Middle East.
Background: Continuous subcutaneous foslevodopa/foscarbidopa is an emerging 24-hour levodopa delivery system for advanced Parkinson’s disease, yet nursing guidance and institutional policies for safe delivery remain limited in new programmes. In January 2025,our centre established the first regional inpatient service, requiring new nursing competencies, pathway documents, and risk-mitigation strategies aligned with hospital governance.
Method: A multidisciplinary working group co-developed eligibility criteria; an inpatient titration/observation pathway; EMR nursing documentation templates; pump safety procedures (double checks, line tracing, interruption management, MRI/OR workflows); and discharge/handover checklists. Education used competency-based skills checklists, bedside coaching during the first 10-15 cases, and simulation with training pumps. Policies were ratified through nursing leadership and quality/safety governance.
Results: Nursing responsibilities were formalized across clinical care, patient/caregiver education, and safety/escalation. Challenges included rapid upskilling of unit nurses unfamiliar with continuous subcutaneous systems and unclear accountability during cross-department transfers (radiology, ICU, OR). Mitigations included mandatory competencies, unit quick-reference guides, standardized handover items, and a clear escalation algorithm involving neurology and on-call pharmacy.
Conclusion: Establishing a structured nursing framework spanning competencies, EMR‑embedded documentation, and formalized policies was essential for the safe and sustainable delivery of foslevodopa/foscarbidopa infusion therapy in a new program. This experience underscores the central role of specialized movement disorder nursing in coordinating care, embedding safety systems, and supporting multidisciplinary service delivery, and provides a practical template that other centres can adapt when introducing continuous subcutaneous levodopa therapies.
References: 1. Espay AJ, Stocchi F, Fung VSC, et al. Safety and efficacy of continuous subcutaneous foslevodopa foscarbidopa in Parkinson’s disease: a randomized, double blind, phase 3 trial. Nature Medicine. 2022;28:747–755.
2. Fung VSC, Aldred J, Arroyo MP, et al. Continuous subcutaneous foslevodopa/foscarbidopa infusion for the treatment of motor fluctuations in Parkinson’s disease: considerations for initiation and maintenance. Clinical Parkinsonism & Related Disorders. 2024;10:100239.
3. Schröter N, Sajonz BEA, Jost WH, et al. Advanced therapies in Parkinson’s disease: an individualized approach to their indication. Journal of Neural Transmission. 2024;131:1285–1293.
To cite this abstract in AMA style:
E. de Freitas, S. Mittal. From Vision to Reality: Nursing Driven Implementation, Policy, and Safety Framework for Foslevodopa/Foscarbidopa Continuous Subcutaneous Infusion in a Tertiary Movement Disorder Centre [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/from-vision-to-reality-nursing-driven-implementation-policy-and-safety-framework-for-foslevodopa-foscarbidopa-continuous-subcutaneous-infusion-in-a-tertiary-movement-disorder-centre/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/from-vision-to-reality-nursing-driven-implementation-policy-and-safety-framework-for-foslevodopa-foscarbidopa-continuous-subcutaneous-infusion-in-a-tertiary-movement-disorder-centre/