Making Hospitals Safer for People with Parkinson's Disease

This report highlights the challenges and risks inherent in hospital care for people with Parkinson’s disease (PD) and provides recommendations for clinical and administrative staff. These protocols will help hospitals put in place the recommended best practices to make care safer for people with PD and in doing so, aim to improve health outcomes and quality of life.

The Challenges

The Parkinson’s Foundation created its Hospital Care Initiative to improve hospital safety for people with PD. This effort builds on the Foundation’s long history of leadership in driving awareness of hospital safety for people with PD and the need to promote further change. During the last decade, the Foundation has moved this work forward through launching tools and programs, such as the Aware in Care hospital safety kit. The Foundation has also provided multidisciplinary clinician training and education, and funded pilot hospital care improvement programs and clinical research.

Today, the Foundation’s Hospital Care Initiative continues to build on this work with a focus on three critical challenges faced by people with PD as they encounter a hospitalization:

• Medication mismanagement: Each year, an estimated 167,000 people with PD will experience an avoidable complication due to improper medication management in the hospital.
• Clinical complications: More than a quarter of hospitalized people with PD will experience motor symptom deterioration.
• Lack of care standards: Inconsistent policies and limited understanding of the medication needs of people with PD lead to complications and poorer health outcomes.

The Recommendations

In 2019, the Foundation held the Hospital Convening, which brought together experts in hospital care and Parkinson’s disease, policy makers, and care partners. Through this Convening, subsequent working group meetings, and input from clinical leaders and other stakeholders in the PD community, the Foundation created recommendations in six key focus areas to improve hospital care for people with PD:

 1. Improve Clinical Care

Recommendations include protocols for fall risk management and medication management at admission and during care.

2. Standardize Care Processes and Protocols

Recommendations include checklist protocols for medication reconciliation, hospital admission, perioperative care and hospital discharge.

3. Mobilize Technology

Recommendations include protocols for creating visible identifiers in the electronic medical record, notification of the primary PD care provider upon patient admission and consistent distribution of PD medications and warnings about contraindicated medications.

4. Promote Education

Recommendations include protocols for implementing patient chart identifiers for people with Parkinson’s, training staff on specific PD care needs (including medication timing and improper medication substitutions) and routine education of hospital team members through the Parkinson’s Foundation Team Training program.

5. Transform Culture

Recommendations include protocols for identifying clinical champions to foster dialogue at the hospital level, honoring the role of the person with Parkinson’s and their care partner as experts in managing the disease, implementing policies allowing selfadministration of PD medications when appropriate and establishing interdisciplinary team meetings to align specialty care for people with PD.

6. Drive Policy

Recommendations include standardizing hospital care delivery practices for people with Parkinson’s, establishing a Joint Commission Advanced Certification in Parkinson’s Care and improving health outcomes through the uniform adoption, regulation and standardization of Parkinson’s care criteria.

The Next Steps

These recommendations offer a roadmap of actionable solutions designed to make hospital care safer so that more people with Parkinson’s have the best health outcomes and quality of life. As a longstanding leader in driving better care, the Parkinson’s Foundation is committed to moving these solutions forward by promoting dissemination and implementation of these recommendations, continued evidence generation through research, and ongoing engagement of people with Parkinson’s as our partners in these efforts.