AUTHOR=Chunga Natalia , Amodeo Katherine , Braun Melanie , Valdovinos Blanca Y. , Richard Irene H. 

TITLE=Effect of best practice advisory on the administration of contraindicated medications to hospitalized patients with Parkinson’s disease and related disorders

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=15

YEAR=2023

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2023.1276761

DOI=10.3389/fnagi.2023.1276761

ISSN=1663-4365

ABSTRACT=<sec id="sec1"><title>Objective</title><p>To determine the effect of a Best Practice Advisory (BPA) on the ordering and administration of contraindicated dopamine blocking agents (DBA) to hospitalized patients with Parkinson’s disease (PD) and related disorders.</p></sec><sec id="sec2"><title>Background</title><p>Patients with PD are more likely to require hospitalization and are at increased risk of complications. Administration of contraindicated DBA contributes to worsened outcomes in this patient population. Electronic medical record (EMR) warnings (also referred to as BPA) have been proposed as a way to prevent the administration of contraindicated medications.</p></sec><sec id="sec3"><title>Methods</title><p>A BPA was launched in January 2020 within the University of Rochester EMR system, which alerts the provider when a contraindicated DBA is ordered in hospitalized patients with PD and related disorders. Patients with PD and related disorders hospitalized at two hospitals affiliated to the University of Rochester during a time period before (<italic>t1</italic>: 1/1/2019–1/1/2020) and after (<italic>t2</italic>: 1/8/2020–1/8/2021) the implementation of the BPA were included in this study. Epic SliderDicer was used to collect the data from the University of Rochester EMR. The number of patients who had contraindicated DBA orders and administrations in both time periods, and the number of patients who had the BPA triggered during <italic>t2</italic> were obtained. We compared the results before and after the implementation of the BPA.</p></sec><sec id="sec4"><title>Results</title><p>306 patients with PD and related disorders were hospitalized during <italic>t1</italic> and 273 during <italic>t2</italic>. There was significantly less percentage of patients who had contraindicated DBA orders (41.5% in <italic>t1</italic> vs. 17.6% in <italic>t2</italic>) and patients who had contraindicated DBA administrations (16% in <italic>t1</italic> vs. 8.8% in <italic>t2</italic>) during <italic>t2</italic> (<italic>p</italic> &lt; 0.05 for both comparisons). There was no significant difference between the percentage of patients who had contraindicated DBA orders in <italic>t1</italic> and patients with attempted orders (BPA triggered) in <italic>t2</italic> (<italic>p</italic> = 0.27).</p></sec><sec id="sec5"><title>Conclusion</title><p>The results of this study increase the evidence of the potential benefit of EMR warnings for the optimization of inpatient medication management in patients with PD and related disorders. In particular, our results suggest that EMR warnings help reduce the administration of contraindicated medications, which is a known contributing factor for hospital complications in this patient population.</p></sec>