Parkinson's Disease Admission Order Set Toolkit

People with Parkinson’s disease (PwP) are especially vulnerable to medication errors when hospitalized given the patient-specific and time-sensitive nature of their medication regimens. Medication errors lead to increased hospital length of stay and increased morbidity and mortality. A retrospective chart review of PwP admitted to Northwestern Memorial Hospital (NMH) from August 2013 to August 2014 found that 50.5% of patients experienced medication error. These medication errors included medication omissions, ordering the wrong dose strength or formulation, and administration at the wrong time. In 2016, an interdisciplinary group of neurologists (including Movement disorder specialist Dr. Cindy Zadikoff, fellow Dr. Yasaman Kianirad and then residents Dr. Danielle Larson and Dr. Mitra Afshari) and pharmacists created a PD-specific admission Order Set for NMH’s electronic medical record (EMR) to enable accurate and timely PD medication administration and alert nurses and physicians to contraindicated medications. The “Parkinson’s Disease Order Set” includes 1) a section title “contraindicated medications” listing medications known to worsen PwP symptoms, with a list of alternative medications for delirium and nausea management, 2) a “medication reconciliation” including all PD medications with option to enter patient-specific doses and times, 3) “Nursing and safety alerts” including a reminder to give all medications on time and fall precautions, and 4) “ancillary services” including physical, occupational and speech therapy orders. This project will seek to improve and disseminate the order set over the next year.