Parkinson’s Foundation issues guidelines to ‘avoid preventable harm’ in hospitals

The Parkinson's Foundation has issued new recommendations to improve the standard of care for hospitalization among individuals with Parkinson’s disease.

These guidelines, published in a brief in The Joint Commission Journal on Quality and Patient Safety and titled, “Protecting Parkinson's Patients: Hospital Care Standards to Avoid Preventable Harm,” were crafted by six health care experts, headed by lead author Peter Pronovost, MD, PhD, FCCM, chief quality and transformation officer at University Hospitals Cleveland Medical Center.

The guidelines identify five ways to bolster care during hospitalization, while also providing a general framework for how these methods can lead to a successful and practical care model for all health care environments that specialize in treating PD.

A rationale for the updated framework was based on the foundation’s hospital care recommendations released in April 2023, originally developed in concert with a broad panel of health care industry experts hailing from the University of Florida Health, Hackensack Meridian Health and Henry Ford Health.

“About a decade ago, people started to look at why Parkinson’s patients were having a harder time in the hospital, putting them at risk for falls, inability to swallow, confusion, and more,” co-author Hooman Azmi, MD, director of Functional and Restorative Neurosurgery at Hackensack University Medical Center, told Healio. “We put together a protocol initially for patients undergoing surgery, but then expanded to our whole hospital to pay attention to Parkinson’s patients getting their medications on their very specific schedule and not prescribed contraindicated medications, including common postoperative medications and anti-anxiety medications.”

“Preventable harm” that individuals hospitalized due to symptoms of PD experience may include extended stays or adverse disease-related outcomes. Hospitalization may be prolonged due to delayed or ineffective treatment, as well as for symptom worsening and physical decline.

Adverse outcomes may be temporary, such as when a patient experiences elevated rates of delirium, or permanent, such as physical and psychological damage and increased mortality.

The following recommendations attempted to establish a consensus on sustainable hospital care standards for both health care providers and patients alike to cover all eventualities. Each was designed to address existing gaps in the care continuum that were found to contribute significantly to patient harm.

• Medications for PD should be ordered according to the patient’s customized needs as well as their respective at-home regimens.
• These medications should be administered within 15 minutes of patients’ previously established at-home regimen, without exception.
• All medication that may be potentially harmful to the patient should be eliminated, with particular attention paid to dopamine-blocking medications, pain medications and other sedatives.
• All individuals with PD should be mobile three times a day at minimum, if clinically appropriate, and guided by professional supervision if needed.
• Screening for dysphagia should occur within 24 hours of admission for all PD-affected individuals, with sufficient measures in place to reduce risk of aspiration pneumonia.

“This article reveals that we have a fundamental obligation to ensure that the patients facing the greatest risk in the hospital are safe, such as those with PD who face disproportionate rates of preventable and unintended harm,” Pronovost said in the release. “For patients living with Parkinson's, the recommendations represent an invaluable, practical care model for all hospitals and health systems.”

Reference:

Pronovost P, et al. Jt Comm J Qual Patient Saf. 2024;doi:10.1016/j.jcjq.2024.08.004.