Improving Medication Safety in Dysphagic Parkinson’s Disease Patients through the Dysphagia Alert Card Initiative

Introduction:
Dysphagia in Parkinson’s disease (PD) increases the risk of aspiration pneumonia and medication harm during acute admissions. When patients are made nil by mouth (NBM), time critical PD medicines may be delayed while clinicians calculate levodopa equivalent dose (LED) and convert to alternative formulations. We introduced a patient held Dysphagia Alert Card to provide a specialist approved emergency prescribing plan and improve timely prescribing and review.

Method:
Patients with established dysphagia or high risk were identified during routine specialist reviews and inpatient referrals. The PD specialist team calculated an individual LED using a standardised calculator and designed a personalised alternative regimen for periods when oral medicines could not be safely taken. Regimen selection incorporated neuropsychiatric risk to support safe dosing of alternatives medications. The plan was issued as a durable credit card sized plastic card for patients to present to ambulance crews, hospital staff or their GP. Details were also communicated by GP letter and embedded in the hospital electronic record. Patient pathway coordinator maintained a live register, updated plans after medication changes, and ensured routine review every 3–6 months.

Results:
We compared a pre implementation cohort (n=11) with a post-implementation cohort (n=10). On time administration of the next scheduled dopaminergic dose after dysphagia/NBM recognition improved from 54.5% (6/11) to 90.0% (9/10). Requests for PD specialist review increased from 54.5% (6/11) to 90.0% (9/10), and time to finalise an appropriate alternative regimen was 0–2 days in 90% of post implementation patients. SALT referral rates differed between cohorts (63.6% vs 50.0%).

Conclusion(s):
The Dysphagia Alert Card, embedded within a coordinator monitored pathway, improved timely dopaminergic administration and escalation to PD specialist review, providing a practical bridge to multidisciplinary care during acute illness. This low cost intervention strengthens continuity across multiple settings and reduces the risk of medication omissions in dysphagic PD

Reference:

1. National Institute for Health and Care Excellence (NICE). Parkinson’s disease in adults (NG71). Published 19 July 2017.
2. Parkinson’s UK. Get It On Time campaign (time-critical Parkinson’s medication in hospital). Accessed 24 January 2026.
3. National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Dysphagia in Parkinson’s Disease (Hard to Swallow?). Published 12 August 2021.
4. Won JH, Byun SJ, Oh B-M, Park SJ, Seo HG. Risk and mortality of aspiration pneumonia in Parkinson’s disease: a nationwide database study. Scientific Reports. 2021;11:6597. doi:10.1038/s41598-021-86011-w. PMCID: PMC7988066. PMID: 33758213.