Dr. Holly Shill Stresses Importance of Medications for Hospitalized Parkinson’s Patients
Physicians, nurses, and other staff at Barrow Neurological Institute are involved in a concerted effort to improve the outcomes of people with Parkinson’s disease who are hospitalized.
Neurologist Dr. Holly Shill, director of the Muhammad Ali Parkinson Center at Barrow, said it is important to raise awareness throughout the hospital about the issues affecting Parkinson’s disease patients because many of them need services other than neurology. (Watch Dr. Shill’s talk)
People with Parkinson’s disease are hospitalized for a variety of reasons, including falls, pneumonia, cardiac problems, urinary tract infections, gastrointestinal problems, cancer, dementia, syncope, and stroke.
Dr. Shill said medication non-compliance is the main issue affecting hospitalized Parkinson’s disease patients. These patients may not be given their medication on time, not given their medication at all, or given an inappropriate substitute. They may also be given dopamine-blocking drugs, which negate the benefits of levodopa – the standard medication for Parkinson’s disease.
Studies have shown that medication non-compliance may increase the risk of deterioration and infection in Parkinson’s disease patients, and may also contribute to longer hospital stays.
Barrow and other Dignity Health facilities have implemented several practices to improve outcomes for Parkinson’s patients, including expedited reconciliation of medications.
“If patients are recognized as having Parkinson’s disease anywhere throughout our system, their medications are entered with the help of the pharmacy, a provider reconciles them, and then patients get their medications almost as fast as they hit the door if they need them,” Dr. Shill said.
An alert system has been implemented on hospital computers to notify providers when they attempt to order contraindicated medications for Parkinson’s patients, such as dopamine blockers.
Dr. Shill said nurses have been instructed that when administering Parkinson’s medication, they have a 15-minute window before and after the time the patient usually takes the medication.
Another part of the effort is to continue to provide education to nurses and physicians on the importance of medication compliance for Parkinson’s patients, and what they can do to help improve outcomes.
“The natural follow-up for this is to see how well we’re doing,” Dr. Shill said. “Now that all the alerts and precautions are in place, are we doing a better job? Are we improving outcomes? I think we’re one of the first places in the country that is starting to do this in a very systematic way, and that’s because of the efforts of the people involved.”
The National Parkinson Foundation is also spreading awareness about the importance of medication compliance in the hospital but with a focus on educating people with Parkinson’s disease. The foundation launched the “Aware in Care” campaign in 2011 to help people who may become hospitalized be proactive in their care.