Assessment of appropriate medication administration for hospitalized patients with Parkinson's disease.

BACKGROUND: For Parkinson's disease (PD) patients, adherence to a regular PD medication schedule is important in achieving optimal symptom control. There are few published studies quantifying PD medication administrations in hospitalized PD patients. METHODS: Hospitalization records for 100 veterans with idiopathic PD and admitted to our center were reviewed to determine the on time rate and contraindicated medication doses. A barcode based computerized medication administration system within the electronic medical record provided information of the exact time the medication was given to a patient. RESULTS: Eighty-nine idiopathic PD patients met study inclusion criteria. Among them, 87 were on levodopa monotherapy or in combination with other PD medications. Two patients were on dopamine agonists only. A total of 3873 doses of PD medications were prescribed during hospitalization. Among 675 incorrect medication administrations, 322 doses were omitted, 300 doses late by ≥ 30 min, and 53 doses given early by ≥ 30 min. Contraindicated medications were prescribed for 19 patients. The correct administration percentage was lower during the first 2 days post-admission compared to subsequent days (mean 74.6% vs. 82.8%) and higher for patients who had neurological consultations (mean 85.5% vs. 76.5%). Correct administration rates were better for patient-based medication schedules (85.6%) than with hospital-based schedules (77.5%), but did not achieve statistical significance. CONCLUSION: Adherence to regular PD medication dosing schedules during hospitalization is problematic, but improves with specialist consultation. Staff involved in the admission process for PD patients should work to safeguard against disruption of the prescribed home dosing schedule.

Using telehealth to educate Parkinson's disease patients about complicated medication regimens.

Parkinson's disease (PD) primarily affects older adults, who manage their symptoms with complex medicine regimens. This mixed-methods study evaluated the usefulness and usability of follow-up telehealth medication counseling with a sample of community-based PD patients. Patients taking three or more medications for Parkinson's disease were randomly assigned to the teaching modalities of videophone or telephone. A self-care standardized medication educational session lasting 20 to 30 minutes was conducted, and patient and nurse usefulness of the intervention was evaluated by responses to a 15-question Likert scale and elicited comments. Patients' satisfaction with the intervention involved patterns of time, education, and technology. Videophone users were more satisfied with the equipment and counseling. Videophones were considered easy access to supportive, expert neuroscience nurses. Overall, videophone counseling sessions were significantly more useful than the telephone sessions (t[34] = 0.896, p = 0.004, 95% confidence interval = 1.90 to 3.12). Nurses found visualization via videophone significantly more useful for medication and self-management interactions.