CP-155 Missed and delayed doses of Parkinson's medicines at North Bristol NHS Trust (NBT) (UK). (24th February 2014) - Walker, K
Abstract : Background: Timing for Parkinson medicines is crucial as a delay can significantly affect Parkinson symptoms and prolong hospital admission. The National Patient Safety Agency (NPSA) 'reducing harm from omitted and delayed medicines in hospital' states a critical list should contain Parkinson medicines. Purpose: NBT conducted service developments/audits to improve missed doses. No work has focused on the timing for critical listed medicines. Tests of change aimed to improve the timing of Parkinson medicines administration. Materials and methods: A retrospective study captured doses on time (≤30 min), delayed (1–3 h time frames) or missed (>4 h), on Elderly/Neurology wards from November to January 2013. Standards were obtained from Parkinson's UK. Tests of change encouraged Doctors/Pharmacists to endorse times for Parkinson medicines and apply yellow 'Get it On Time' (GIOT) stickers to drug charts, highlighting patients to ward staff. Ward posters obtained approval from Parkinson's UK to utilise the National campaign GIOT. The re-audit determined any improvements in doses given 'on time' and patient questionnaires discovered whether any adverse symptoms occurred, if a dose was delayed in a particular time frame. Results: Total number of doses audited in 1st audit = 436 and re-audit = 202. Missed doses in the 1st audit = 2% and re-audit = 6%. Further delays/omissions did not occur 70% in the 1st audit and 62% re-audit. When comparing doses 'on time' with no intervention 52% doses were on time; with intervention 72% doses on time. Stickers and administration times were endorsed on 52% drug charts in 1st audit and 92% re-audit. No critical list of medicines is recommended by NBT. 5 patient questionnaires showed all Parkinson's medicines were reconciled on admission with no dose delays/omissions worsening symptoms. Self-administration, staff awareness of Parkinson's/timing and liaising with the NBT Specialist Parkinson nurse, were key themes which required improvement. Conclusions: No standards set by Parkinson's UK were adhered to. A dose 'on time' was considered ≤30 min as no National guideline exists. Doses on time did not improve after tests of change, as limitations were less re-audit data was collected and several delayed doses (>2 h) skewed the data. Admission times were not consistently documented; therefore although delays in the 1st dose were near 100%, this may be less. No 'critical list' of medicines is recommended by NBT as the Medicines Governance group agreed each medicine is important to be on time. Endorsing administration times and GIOT stickers increased the number of doses on time by 20%. These interventions are now recommended in the NBT 'Medicines Management policy' for consistent use. Further work is required to achieve the standards from Parkinson's UK. Future audits may consider a larger data collection, pill timers to aid nurses of specific timings and overall staff awareness of Parkinson's medicine management. See supporting information for ward poster. No conflict of interest.