Reducing Delays in Prescribing and Administration of Parkinson’s Disease (PD) Medication – The impact of awareness raising, understanding professionals’ and patients’ perspectives and system change

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Sarah Collis 1, Catherine Wiliams 2, Đula Alićehajić-Bečić 3, Alison Unsworth 3
1- Manchester University Teaching Hospitals Foundation Trust. 2 - North Wales NHS trust, 3- Writhington, Wigan and Leigh NHS Foundation Trust
Clinical Quality
CQ - Clinical Effectiveness
Quality Improvement

Abstract

  1. Introduction

Royal College of Emergency Medicine and NHS England define reduction of delays and omissions of critical medication as important strategic objectives. Data from Parkinson’s UK indicate that only 37% of doses of PD medication are delivered on time during hospital stays. The aim of this QI project was to evaluate data from previous 2.5 years and evaluate effectiveness of our improvement work.

  2. Method

Utilising hospital electronic reporting system, information was obtained on time from Emergency Department (ED) Triage document completion to time that PD medication was prescribed. Data on administration within 30mins was analysed for 3 months (July + Nov 2023 and June 2024). Questionnaires were sent to nurses, doctors and patients to obtain their perspectives. Electronic system was updated to include “is the patient on time critical medication (TCM)” question on ED Triage document and analysis of its effect was completed.

  1. Results

For co-beneldopa, the average time from triage to first prescription decreased from 320mins in 2023, to 280mins in 2024 rising slightly to 301mins for the first 5 months of 2025. For co-careldopa those figures were 277mins/359mins/218mins for the 3 years. Delays to administering of medication were more prominent in November 23 (range 49-52% given within 30minutes of scheduled time) vs July 23 (range 60-69%) and June 24 (range 66-71%). Doctors reported low confidence in prescribing PD medication, while nurses outlined various barriers to timely administration. Two thirds of patients were satisfied with PD meds in hospital. Following introduction of TCM question in Triage document, time from ED triage to first prescription has gone down to 150mins for co-careldopa and 259mins for co-beneldopa.

4. Conclusion(s)

Multiple interventions were introduced through the 2.5 years to improve performance. We need to continue this work to ensure that patients with PD get their medication on time. 

Comments

Thank you for this great project. Did patient satisfaction continue to improve after adding the ‘critical medication’ question to the triage document?

Submitted by HATICE.EKICI_31491 on

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Thanks for your question! The project is still in progress, so it’s something we’re continuing to explore - we’re really interested to see how these changes might impact patient satisfaction!

...have I understood correctly this was mostly driven by the TCM question on the traige form? Rather than the education sessions etc. I have previously found it is very hard to get education-based interventions to 'stick' as assessed by similar projects. 

Submitted by beccafrake_22656 on

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Hi! Thanks for your question. Initially we found numerous barriers contributing to delays so a multi-modal approach was likely best to tackle these issues. Though education is key, we found this is most impactful when supported by system changes, including the triage question and visual reminder on the electronic system, to empower staff to put their learning into practice and create lasting improvements.

PD medications are quite critical for patients who have been on them and missing doses due to delays can have significant adverse health impacts. I hope this improvement is sustained. Well done!

Submitted by adeyemiolugben… on

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Thank you! Our team is hopeful that this system change will lead to meaningful, long-term improvements.

Submitted by sarahjaynecoll… on

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Very relevant issue in every hospital. I believe the main constraint to timely prescription is lack of knowledge about dose and timing especially when the patients are unable to say and sometimes the information is not updated in the GP records. In addition to the intervention started by your team, another helpful step might be to create a system where the community pharmacist reviews these medications every 2-4 weeks and makes sure that the details are updated accurately.

Submitted by hindol.dasgupt… on

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This is a very interesting and insightful audit. As mentioned in your study, there is often less confidence regarding anti-parkinson's medication prescriptions. Often this is compounded by the patient being made by NBM for any reason and having to switch the oral medications to its alternatives. Would such instances have significantly delayed prescription of time-critical medications in the absence of clear guidelines?

Submitted by rachanabiju099… on

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Thanks for your comment! I agree that the lack of awareness and clear guidelines is common, often leading to reduced prescribing confidence and delays. This would be an interesting area for future focus!

A valuable project with clear improvements, but results vary across years and would benefit from clearer links to specific interventions. Questionnaire findings lack detail on response rates, limiting interpretation. The new triage question shows promise, but its real-world uptake isn’t fully explored. Strong foundation, but analysis could be sharper.

Submitted by avtar.singh@wa… on

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