Blogs

Improving the care in hospital for people with Parkinson’s

Our consultant geriatrician, Dr James Fisher, talks about a project to improve the experience of Parkinson’s patients by focusing on medication.

This involved a number of our services, represented by Amanda Gordon (practice development lead) Rachel Carter (director of patient safety), Amber Cruddos (practice development nurse), Suzanne Herkes (patient safety improvement facilitator), Charlotte Scott (senior clinical pharmacist), Rachel Magee (speech and language therapist), Elaine Bolam (speech and language therapist), Michael Hardy (pharmacy technician team leader: informatics), Dr Giovanni Di Paolo (internal medicine trainee), Callum Brown (improvement facilitator, patient safety and improvement team)

The range of symptoms in Parkinson’s means that gold-standard care demands a multi-disciplinary approach. We knew from the start of our work that we needed a diverse team of professionals. We gathered a team including speech and language therapists, nurses, pharmacists, patient safety experts, senior and junior doctors.

This team has been working hard to improve care for people with Parkinson’s in our hospitals. We were delighted to be recognised for the work we’ve been doing with a couple of recent awards:

• The Bright Ideas in Health Awards 2024 - Demonstrating an impact on patient safety
• The Healthcare Quality Improvement Partnership Patient Safety Hero 2024

Our aim was to improve medicines administration, as research tells us that this often goes awry in hospital for people with Parkinson’s. This makes their symptoms much worse and extends their recovery. For a Parkinson’s medicine, we wanted to make sure someone in our hospitals can be confident that they will, as Parkinson’s UK puts it, ‘get it on time’.

The trust supported our work by adopting our project as one of their annual safety and quality priorities for 2023-24 and 2024-25.  Our agreed targets were:

• To eliminate delays of more than 60 minutes for Parkinson's medications
• To ensure that 95% of patients receive their Parkinson's medications within 30 minutes of the prescribed time

Recognising and treating swallowing problems has also been highlighted in a national report as an area for improvement, so this too was a focus for our work.

To tackle these challenges, we came up with a range of ideas that were brought in over time, while medication data was regularly monitored to see how we were doing.

What did we do?

We produced a safety briefing video for all staff.

We redesigned the trust guidelines for Parkinson’s to make them more practical and useful. They now provide an overview of what the first 24-48 hours of a hospital admission ought to look like for a patient. A guide to managing commonly encountered problems (e.g. My patient can’t swallow their meds) was also included.

A micro-teaching session, lasting only 3 minutes, was delivered across our target wards. The training had four key messages:

• Get it on time
• Think swallow
• Zero tolerance for missed meds
• Contact the Parkinson’s team

Teaching was delivered to staff in their workplace, allowing us to reach all members of the team. In total, 172 staff across 3 wards received the teaching and, since April 2024, 105 staff in the emergency department have also been trained.

A key innovation was the development of an online medicine calculator – PDMedCalc.co.uk. This allows clinicians to calculate a non-oral dose for patients unable to take their usual oral medicines due to swallowing problems. Development of this tool was supported by Parkinson’s UK. They helped fund its development and signpost professionals to it on their website. PDMedCalc, which has been approved by the medical device regulator (MHRA), is part of our guidelines now and staff were alerted to it during training.

The micro-teaching also included video footage of a patient whose medications were 30 minutes late, displaying severe mobility problems. A second video showed the same patient 30 minutes later, but having had their medicines; strikingly, the person’s walking was near normal. Staff have told us that the video was extremely impactful and memorable. It helped get the learning across of the need to prioritise the care of people with Parkinson's.

A screensaver, displayed on all trust computers when not in use, was launched to provide a visual reminder of the 4 key messages from the micro-teaching.

The electronic forms that nurses use to assess patients was amended to include a visual prompt to do a swallow assessment for a patient with Parkinson’s. But we also re-orientated the training on this, so that all members of the team can do it. The message is that a swallow assessment could be done by any trained, qualified staff member, not just by members of the nursing staff.

Did it work?

We know from medication data that the above things have had a positive impact on medicines administration.

The proportion of people whose Parkinson’s medicines have been delayed has dropped significantly, with more people than ever “getting it on time”.

We also know that the medication calculator is being used by healthcare professionals widely - locally, nationally and internationally.

Work continues to maintain these improvements. Delivery of the micro-teaching to staff members in the emergency department continues. Recent education has also been delivered to members of staff in the North East Ambulance Service.

Trust staff with a particular interest in Parkinson’s have been sought out and a pool of ‘local champions’ identified. These colleagues have since received additional training from the team and, to maintain the momentum of the project, they continue to reinforce the messages in their own workplaces.