ABSTRACT
BACKGROUND: Patients hospitalized with Parkinson's disease (PD) require timely delivery of carbidopa-levodopa (C/L) medication. Ill-timed administration of C/L doses is associated with greater morbidity and longer lengths of stay. OBJECTIVE: To understand the barriers to timely C/L administration, and implement strategies to improve the administration of the drug to hospitalized PD patients. METHODS: Several key strategies were employed in 2015 to improve the timely delivery of C/L doses: 1. three kinds of nursing alert in the electronic medical record (EMR); 2. staff in-service education; 3. stocking immediate-release C/L into automated medication dispensing machines on key hospital units; 4. reports to nurse unit managers on timeliness of C/L administration; and 5. reconciliation of inpatient and outpatient levodopa orders by the hospital pharmacist upon admission. The primary outcome was the percent of C/L doses administered within 60, 30, and 15 minutes of scheduled time. RESULTS: Our urban hospital, affiliated with a Parkinson's Foundation Center of Excellence, had 5,939 C/L administrations in 2018. There was sustained improvement in timely delivery of doses, from 89.3% in 2012 to 96.5% in 2018 (within 60 minutes of the scheduled time), 65.5% to 86.4% (30 minutes), and 42.3% to 71.1% (15 minutes) (all pâ<â0.001). CONCLUSIONS: With multifaceted but relatively simple measures, we were able to "change the culture" so that hospitalized patients with Parkinson's disease receive levodopa on time.
Subject(s)
Dopamine Agonists/administration & dosage , Hospital Departments , Hospitalization , Levodopa/administration & dosage , Parkinson Disease/drug therapy , Parkinson Disease/nursing , Quality Improvement , Aged , Carbidopa/administration & dosage , Drug Combinations , Female , Hospital Departments/organization & administration , Hospital Departments/standards , Hospitals, Urban , Humans , Length of Stay , Male , Middle Aged , Process Assessment, Health Care , Time FactorsABSTRACT
Becoming a site for Nurses Improving Care for Healthsystem Elders (NICHE) is an exciting way to improve the care of hospitalized elders. This article describes how a community-based hospital implemented the Geriatric Resource Nurse (GRN) Model on an orthopedic and acute medical surgical unit. Key elements of the program included focusing on a specific geriatric syndrome (acute confusion) and using outcome data to target practice changes. As a result, the incidence of acute confusion and the percentage of acutely confused patients at discharge decreased.
