AUTHOR=Goldin Caroline , Sillau Stefan , Worledge Elisa , Bremmer Jarrett , Cummins Robbie , Tremolet de Villers Kathryn , Fullard Michelle E. TITLE=Reducing the receipt of contraindicated medications in patients with Parkinson disease JOURNAL=Frontiers in Aging Neuroscience VOLUME=15 YEAR=2023 URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2023.1271072 DOI=10.3389/fnagi.2023.1271072 ISSN=1663-4365 ABSTRACT=Background

The administration of antidopaminergic medications to patients with Parkinson’s disease (PD) can exacerbate symptoms, and in the hospital setting, can lead to complications and increased length of stay. Despite efforts to improve medication administration through provider education and patient-centered interventions, the problem persists, with an estimated 21–43% of hospitalized PD patients receiving dopamine blocking medications.

Methods

In this study, a best practice alert (BPA) was developed that was triggered when an antidopaminergic medication was ordered in the Emergency Department or hospital for a patient with a diagnosis of PD in the EMR. The primary outcomes were receipt of a contraindicated medication, length of stay (LOS) and readmission within 30 days. These outcomes were compared between the 12 months prior to the intervention and the 12 months post intervention. Data were also collected on admitting diagnosis, admitting service, neurology involvement and patient demographics.

Results

For pre-intervention inpatient encounters, 18.3% involved the use of a contraindicated medication. This was reduced to 9.4% of all inpatient encounters for PD patients in the first 3 months post-intervention and remained lower at 13.3% for the full 12 months post-intervention. The overall rate of contraindicated medication use was low for ED visits at 4.7% pre-intervention and 5.7% post-intervention. Receipt of a contraindicated medication increased the risk of a longer length of stay, both before and after the intervention, but did not significantly affect 30-day readmission rate.

Conclusion

An EMR BPA decreased the use of contraindicated medications for PD patients in the hospital setting, especially in the first 3 months. Strategies are still needed to reduce alert fatigue in order to maintain initial improvements.