Multi-faceted Intervention Improves Timeliness of Treatments in Hospitals

A multi-faceted intervention that included staff education, electronic alerts, and requiring new reports, improved the timeliness with which Parkinson’s disease patients were given medication in a hospital setting, a new study reports.

This suggests that similar interventions might aid in the timeliness of Parkinson’s treatments in other hospitals.

The study, “Quality Improvement in Parkinson’s Disease: A Successful Program to Enhance Timely Administration of Levodopa in the Hospital,” was published in the Journal of Parkinson’s Disease.

People with Parkinson’s are commonly hospitalized, but being in the hospital can impose barriers to providing optimal care. In particular, many people with Parkinson’s require treatment with multiple medications, or require frequent dosing with medications, or both, in order to adequately control their symptoms.

In hospitals, getting these patients the appropriate treatment on time remains  a major obstacle for providing quality care. This also contributes to worse treatment outcomes and longer hospital stays.

The new study reports the results of quality improvement measures that were implemented at the Struthers Parkinson’s Center, a specialty center that treats about 2,000 individuals with Parkinson’s disease and related conditions, and the 361-bed Park Nicollet Methodist Hospital, which is affiliated with the center. Both facilities are in Minnesota.

“Previous studies have shown that neither patients with PD [Parkinson’s disease] nor PD specialists are confident that PD medications are administered on time in the hospital setting, and up to 30% of carbidopa-levodopa doses are not given within an hour of the scheduled time,” study co-author Martha A. Nance, MD, of Struthers, said in a press release. “Through a collaborative effort at our hospital that included contributions from PD specialists, hospitalist physicians, pharmacists, nurses, nursing administration, and information technology — and most importantly, patients and families — we were able to introduce strategies to substantially improve the timely administration of doses.”

Multiple different quality improvement measures were taken. First, new alerts were added to the electronic record-keeping system, such that carers would be reminded of upcoming doses. In addition to being reminders of doses, these alerts served as a form of continuing education to providers, giving information about the importance of timely dosages.

Another measure taken was requiring nurse unit managers for the timeliness of treatment administration. Reports on treatment use for hospitalized individuals also were given to the decentralized hospital pharmacist, in order to keep track of treatments ordered both inside and outside of the hospital.

Finally, immediate-release products containing carbidopa-levodopa — a Parkinson’s treatment that was the focus of the study — were stocked into automated dispensing machines at nursing stations.

The design of the quality improvement program began in 2012, at which time the center began keeping detailed records of when carbidopa-levodopa doses were given on time or not. The program itself was implemented in 2015 and 2016. The study presents data on the timeliness of carbidopa-levodopa doses through 2018.

From 2012 to 2014 (before the program was implemented), 42.3% of carbidopa-levodopa doses were administered within 15 minutes, 65.5% were given within 30 minutes, and 89.3% were given within an hour of when they were scheduled.

These rates increased markedly following the implementation of the program. By 2018, 71.1% of carbidopa-levodopa doses were administered within 15 minutes, 86.4% were given within 30 minutes, and 96.5% were given within an hour of when they were scheduled. All of these rates were significantly greater than the rates in 2012.

Statistical analyses indicated that carbidopa-levodopa doses within 15 minutes of when they were scheduled were more likely for men, on the first day of hospital admission, and between the hours of midnight and 6 a.m.

“In summary, we improved on-time administration of levodopa to hospitalized Parkinson’s patients through a quality improvement initiative that included staff education, and the enduring use of pharmacist interventions and [electronic medical record]-based tools for nursing,” the researchers concluded. “The net result has been a cultural change, whereby physicians, nurses, and pharmacists throughout the hospital recognize the importance of timely administration of levodopa to the comfort and function of the hospitalized PD patient.”

These results suggest that similar interventions could be implemented at other care centers in order to improve the timeliness of Parkinson’s treatments.

“We believe that the measures we instituted can be implemented in other hospitals, and that they will improve the safety, well-being, and outcomes of hospitalized PD patients,” Nance said.

“Anecdotally,” Nance added, “patients have reported being surprised and pleased that nurses were reminding them that medication doses were due soon, rather than the other way around!”