Hospital Care Initiative

Two nurses taking care of patient in hospital

The Parkinson’s Foundation Hospital Care Initiative aims to eliminate preventable harm and promote higher reliability in care for people with Parkinson’s disease (PD) in the hospital.

The vision of the Parkinson’s Foundation is for all people to have access to equitable and quality Parkinson’s care. When people with Parkinson’s receive quality Parkinson’s care, they can better manage their PD symptoms —and maximize quality of life. We provide best-practice care training, the latest information and access to educational tools for doctors, nurses and every member of the health care team.

Hospital Care Initiative

The Problem

Each year more than 300,000 people with Parkinson’s disease receive hospital care in the U.S. Whether unexpected or planned, a hospital visit puts a person with PD at significant risk of avoidable complications that can lead to longer hospital stays, more severe PD symptoms, and increased costs. We estimate that every year, 1 in 6 people with Parkinson’s will experience avoidable complications in the hospital, often related to issues with medication management, mobility and dysphagia.

How We Are Addressing It

The Parkinson’s Foundation is committed to leading the national effort to improve hospital care through systemic changes in areas of policy, technology, culture and education. Our Hospital Care Initiative aims to eliminate preventable harm and promote higher reliability in care for people with Parkinson’s in the hospital. Through this initiative, we have developed key tools and resources for patients and providers.

Parkinson’s Foundation Hospital Care Recommendations

Building on our Making Hospitals Safer for People with Parkinson’s report, Parkinson’s Foundation Hospital Care Recommendations outline five standards of care to improve hospital safety and provide tools to facilitate their implementation. The Recommendations were created in partnership with Hackensack Meridian Health, Henry Ford Health, and the University of Florida Health Norman Fixel Institute for Neurological Diseases, with support from Dr. Peter Pronovost and Manatt Health.

DOWNLOAD HOSPITAL CARE RECOMMENDATIONS

Care Standards

All Parkinson’s medications are ordered in a custom fashion, according to patients’ at-home regimen.

Why it matters: Ordering medications in a custom fashion allows clinicians to provide exact timing on the order that reflects the at-home schedule of people with Parkinson’s. This is essential given the short half-lives of many dopaminergic medications and potentially severe complications caused by deviations in schedules and doses
All Parkinson’s medications are administered within 15 minutes of patients’ at‑home regimen, 100% of the time.

Why it matters: Delivering medication on time every time is essential to preventing harm to people with Parkinson’s, whose symptoms are tightly managed via prescribed patient schedules. There is no defined medication administration window to prevent worse outcomes, but they can appear when medications are delivered early or late by 30–60 minutes, so a more rigorous 15-minute standard for medication administration timeliness must be established to prevent clinical harm.
Potentially harmful medication events are eliminated, particularly in dopamine-blocking medications, agents for pain, and sedatives.

Why it matters: Certain routine and normally benign medications can worsen Parkinson’s symptoms due to their interaction with Parkinson’s medications and the Parkinson’s disease process. Haloperidol, metoclopramide, and prochlorperazine are among the most important contraindicated medications to avoid in the care of people with Parkinson’s to prevent harm. View our list of contraindicated medications.
All people with Parkinson’s should mobilize three times a day if clinically appropriate and under professional supervision if necessary.

Why it matters: Limited movement in people with Parkinson’s can make motor symptoms like festination, freezing, and rigidity more pronounced, which increases fall risk. Early mobilization and effective rehabilitation strategies can reduce movement limitations, decrease fall risk, and prevent secondary complications associated with hospitalization.
All people with Parkinson’s should undergo screening for dysphagia within 24 hours of admittance, with measures taken to minimize the risk of aspiration pneumonia, as needed.

Why it matters: Oropharyngeal dysphagia is common among people with Parkinson’s (80%), yet many people with Parkinson’s are not aware they have it (33%). Screening can ensure providers and people with Parkinson’s are aware of any risks related to swallowing. It is equally imperative that providers recognize the role that medication management plays in aspiration prevention, even when dysphagia is identified. Careful consideration of alternative medication delivery must be part of standard Parkinson’s hospital care.

Parkinson’s Foundation Hospital Care Learning Collaborative

The Parkinson’s Foundation made a significant step toward its vision to eliminate preventable harm and promote higher reliability in care for people with Parkinson’s in the hospital with the launch of its Hospital Care Learning Collaborative in November 2023.

This peer-learning group brings together hospitals, emergency departments, and health systems who are working in their institutions to implement quality improvement projects focused on improving hospital safety for people with PD.

The LC welcomes a wide range of disciplines and roles, including physicians, nurses, administrators, quality leaders, pharmacists, researchers, physical/occupational therapists, speech language pathologists, informaticists, and more. We encourage hospital-wide and system-wide participation to optimize learning and impact.

The first cohort of the Learning Collaborative, made up of twenty leading healthcare systems, concluded in September of 2024.

Cohort 2 will begin in January of 2025. Learn more about joining Cohort 2 by emailing Annie at ABrooks@Parkinson.org.

Explore All Our Care Programs

Palliative Care Initiative

Our goal is to make the palliative care approach available and accessible, to provide support for people with Parkinson’s and family members, at every stage.

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Rehabilitation Medicine

From physical, occupational and speech therapy, this initiative aims to raise awareness of the importance of rehabilitation care in Parkinson’s.

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Our Care Strategy

Find out how we are working to ensure every person with Parkinson’s receives the highest quality care possible, regardless of setting.

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Hospital Care Initiative

The Problem

How We Are Addressing It

Parkinson’s Foundation Hospital Care Recommendations

Care Standards

1. Custom medication orders

2. Timely medication administration

3. Harmful medications eliminated

4. Routine mobilization

5. Screenings for dysphagia

Parkinson’s Foundation Hospital Care Learning Collaborative

Palliative Care Initiative

Rehabilitation Medicine

Our Care Strategy