Abstract
Parkinson’s disease (PD) is a progressive neurological condition which affects approximately 153,000 people in the United Kingdom (1). It classically involves a triad of bradykinesia, rigidity and tremor alongside other significant motor and non-motor features (2). Delayed or missed medications can result in unpleasant motor and non-motor fluctuations (3). Inappropriate management of patient medication has been shown to result in longer length of stay, delayed recovery, and worse overall outcomes (4). Patients with PD have a high risk of complications peri-operatively with evidence showing they are best managed via a multidisciplinary approach (5).The PD team at Aintree University Hospital, part of NHS University Hospitals of Liverpool Group (UHLG), noted that referrals for patients undergoing surgery were low. An initial review of data confirmed that patients undergoing surgery at the site were not having the PD team involved in their care. The acute management of Parkinson’s disease for inpatients guidelines were updated to include more detailed advice around the management of patients with PD undergoing surgery. The second cycle reviewed patients cared for after the intervention had occurred.After the guideline was implemented the number of patients reviewed either pre- or post-operatively by the PD team increased from 4 to 47%.In the initial review there were 640 missed or late doses of PD medications, with only 17% of patients consistently receiving their medications on time. This improved to 56% in the second cohort. Cognitive testing via the 4AT was completed for 38% of patients compared to 18% in the initial cohort. In the second cohort data was collected to review the number of patients with PD who were put first on the operating list, this occurred in 26% of patients. The results show an improvement in all aspects of care that were reviewed. The number of patients seen by the PD team, medications given on time, and cognitive tests performed all improved. Despite this there is still room for improvement; medications are still not being given on time, every time. UHLG has undertaken a trust wide time critical medication quality improvement project which we hope will have a positive impact. Further improvement through education of the surgical and anaesthetic teams and a guideline awareness campaign are planned.