Every Dose Counts: Improving Time-Critical Parkinson's Medication Management in NBM Patients

Parkinson's disease predominantly affects older adults and requires medications to be administered at precise times. Patients who become nil by mouth (NBM) are at risk of delayed or omitted doses, leading to worsening motor symptoms, aspiration, falls, prolonged hospital admission, and Parkinsonism-hyperpyrexia syndrome. Baseline data identified significant gaps in staff knowledge regarding alternative medication routes and local guidance for managing NBM patients.

Methods: This QIP was conducted across the ED, acute medical wards, and elderly care wards at Heartlands Hospital. Baseline multidisciplinary staff knowledge was assessed using a questionnaire. Interventions included multiple teaching sessions delivered within geriatrics and internal medicine departments, educational posters displayed in clinical areas, and promotion of local guidelines and medication conversion tools. A repeat survey was conducted following implementation.

Results: Staff familiarity with managing Parkinson's medications in NBM patients improved substantially. The proportion of respondents reporting they were "very familiar" increased from 8% to 50%, while 48.48% reported being "somewhat familiar" post-intervention. Awareness of alternative medications increased from 64.29% to 94%, and knowledge of where to access local guidance improved from 28.57% to 82%. Recognition that Parkinson's medications are time-critical increased from 92.8% to 100%. Appropriate first-line management by switching to an alternative route or formulation increased from 77.14% to 94%. Knowledge of Rotigotine patch dosing improved from 21.7% to 68.18%, while awareness of correct patch replacement increased from 54% to 89%.

Conclusions: A low-cost, multidisciplinary educational intervention significantly improved staff awareness and confidence in managing Parkinson's medications in NBM patients. Sustainability measures include incorporation into HCOP induction and starter packs, with planned expansion to surgical specialties and junior doctor induction. Adding Parkinson's screening question to admission clerking: "Does this patient take time-critical Parkinson's medications & produceing QR code on posters linking directly to local guidelines and calculators such as PDMedCalc. Future work will aim explore electronic prescribing alerts, standardised NBM prescribing pathways, and patient identification tools to reduce medication delays.