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Clinical Effectiveness
Audit

Survey of prescription and administration of Parkinson’s Disease Medication in a District General Hospital by Althea Lord (St Christopher’s Hospital, Fareham), presented as a clinical effectiveness poster at the BGS Spring Meeting 2005

The audit was undertaken to assess the understanding of prescribing and administering of medication to patients with Parkinson’s Disease, admitted to a District General Hospital. A previous survey [1] concluded that “errors reveal a significant lack of understanding of PD and its management by the physicians caring for these patients”.

Methodology
Patients audited were those admitted to the two District General Hospital sites in Portsmouth – St. Mary’s and Queen Alexandra Hospitals. Twenty patients were identified and medical records, including prescription charts, were examined retrospectively for the first 7 days of admission. Patients were on medical wards (general medicine and elderly medicine), and surgical (general surgical and orthopaedic) wards.

In keeping with current admitting procedures the majority of medical admissions were via the Medical Assessment Unit (MAU). Some medical admissions and all the surgical admissions were via the Accident and Emergency Department (A&E).

Results
Only 1 (a self-medicator) of the 20 patients had no errors in either the prescription or administration of PD medication.

Prescription charts were appropriately written in 13 out of 20 (65%).

There were 56 missed doses in 20 patients, with 2 patients each missing 7 doses. 59% of these missed doses were during the first 2 days of admission. There was no reason for missed doses in 34% (19). The reasons for missed doses were that the chart was written late (18), drug unavailable (9), nil by mouth (3), patient refusal (3), patient too drowsy (3), interhospital transfer (3).

Entacapone was appropriately prescribed in 3 out 4 patients.
3 patients were inappropriately prescribed Metoclopramide. No one was prescribed Haloperidol or Prochlorperazine.

Conclusion
This survey has highlighted a need to increase the understanding of Parksinson’s Disease and the prescription and administration of medication in secondary care. As a result we are conducting educational sessions, developing posters, and looking into people with Parkinson’s Disease self-medicating when admitted to hospital. These issues are being addressed with patients, the Parkinson’s Disease Society, and hospital medical, nursing and therapy staff in order to ensure better patient-centred care.

Acknowledgements
Patients were identified by Pharmacy Staff (Jane Marshall and Sue Higgins) and the data collection was carried out by 2 Senior House Officers (Donna Haydon and Helen Pedgrift). They continue to be actively involved in addressing the issues that have arisen as a result of this survey.

Althea Lord

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