Experts Develop Hospital Care Plan for Parkinson Disease to Prevent Harm

A team of health care professionals developed a hospital care plan for Parkinson disease (PD) to prevent harm among patients. The commentary was published in The Joint Commission Journal on Quality and Patient Safety.

Owing to the growing prevalence of PD and related unintended physical and mental harm, hospital care needs to be made safer for patients. Some of the critical gaps that result in patient harm in PD include medication mismanagement, lack of mobility, and lack of dysphagia prevention and airway management.

In 2023, the Parkinson’s Foundation — in collaboration with an expert panel of physicians, nurses, pharmacists, and therapists — ­­published a framework to improve hospital care for patients with PD. The recommendations highlighted 5 hospital care standards to avoid preventable harm in PD:

• Clinicians should consider ordering PD medications in a customized manner to ensure adequate management for patients. Deviations from consistent at-home schedules increases risk for motor deterioration.

• The panel recommended that PD medications be administered within 15 minutes of patients’ at-home regimen. Although there is limited evidence on the optimal time window for medication administration, early or delayed administration may result in negative outcomes.

• Contraindicated medications, including dopamine-blocking medications, such as haloperidol, metoclopramide, and prochlorperazine, should be avoided in patients with PD. In addition, some medications that are not contraindicated but can pose harm to patients with PD should be used with caution.

• Early mobilization in patients with PD may be beneficial in avoiding complications, despite the lack of consensus on type of mobilization required to prevent harm. Clinicians can consider recommending mobilization at least 3 times a day to patients with PD, if clinically appropriate.

• Patients with PD should be screened for dysphagia within 24 hours of hospitalization because of the risk for mortality related to aspiration pneumonia.

The authors of the commentary concluded, “As such, the Recommendations represent an invaluable, practical care model for all hospitals and health systems that wish to prevent harm in the hospital.”