Vanderbilt Earns National Certification for Parkinson’s Care
The Joint Commission's Gold Seal of Approval is second in the U.S.
Largely for its complex and successful efforts to personalize treatment timing for Parkinson’s patients, the Vanderbilt University Medical Center (VUMC) has received The Joint Commission’s (TJC) Gold Seal of Approval for Parkinson’s Disease Certification.
The Nashville, Tennessee-based VUMC is the nation’s second healthcare organization to receive the TJC‘s Parkinson’s certification, after a TJC representative visited the center in September to review its disease improvement program. The Hackensack University Medical Center, in Hackensack, New Jersey, was certified for Parkinson’s specialty care in 2019.
For more than 70 years, the nonprofit TJC has worked to enable and empower hospitals and other healthcare organizations to improve healthcare quality and patient safety.
The more than 100 certification programs are aimed at improving care by reducing variations. With Parkinson’s, the VUMC now has participated in four different TJC certification programs.
TJC also offers healthcare professionals tools and resources to help improve delivery of care.
Arlene Boudreaux, neurology clinical nurse specialist at VUMC, initiated the Parkinson’s certification quest, the success of which would depend on intricate efforts to personalize the timing of Parkinson’s medication administration at Vanderbilt University Hospital.
“There aren’t really defined criteria from The Joint Commission for Parkinson’s certification,” Boudreaux said in a VUMC press release. “While there’s a generic requirement that you improve patient satisfaction, you’re able to set your own clinical quality goals.”
Because Parkinson’s patients generally work with neurologists to optimize the timing of at-home medications — with the goal of avoiding tremors and walking problems — treatment regimens can become complex and individualized.
When patients are hospitalized, they enter environments where therapies usually are administered according to standardized schedules. This divergence from patients’ personal regimens “can contribute to more delirium, more falls because of more tremors and gait disturbances, and increased inpatient mortality,” Boudreaux said.
Boudreaux pursued program certification after reading about Hackensack’s approval.
“That’s what started it all,” Boudreaux said. “I looked at the data on our Parkinson’s patients and found we had the same problem they’d had in Hackensack.”
“And because we are a massive hospital that tends to rely on standardized medication times, something as simple as ‘do it the way you do it at home’ took us a great deal of time to make happen,” Boudreaux added.
According to Bourdreaux, most of the 350 to 400 Parkinson’s patients admitted every year at the Vanderbilt University Hospital are seen at units other than neurology, and this was the target population for the improvement effort.
Two years ago, the VUMC established a Parkinson’s Disease Quality Improvement Committee, which included Boudreaux and representatives from various departments. Among the steps taken by the committee were:
- Making sure pharmacists more regularly reviewed the medications of patients admitted through the hospital emergency department.
- Adding staffers to pharmaceutical services who meet with newly admitted patients to verify medications taken at home and their associated, individualized regimens.
- Targeting education sessions to nurses and physicians across the hospital.
- Adding to the electronic health record (EHR) system notifications concerning Parkinson’s medication timing.
- Alerting pharmacists whenever a prescription for newly admitted patients appears to vary from their individualized regimen so that will be corrected in the system.
- Adding automatic EHR alerts to discourage the use of medications known to cause problems in Parkinson’s patients.
Notably, the observed-to-expected mortality ratio in the target patient population — one of the outcomes evaluated by the committee — dropped from 1.03 to 0.58 from April-September 2020 to July-September 2022.
“When I look at the numbers, we’re saving about eight lives a year, which may not sound like a lot,” Boudreaux said, “but if you come in here with Parkinson’s and you are terrified that somebody is going to mess up your world, that makes quite a difference.”
Between those two periods, unexpected hospital readmission within 30 days for the target population decreased from 10.8% to 7.6%, and patient satisfaction increased from 3.5 to 4.1 (with 5 being the best).