Improving the prescription and administration of time-critical Parkinson's medication for patients in ambulatory services

Patients with Parkinson's Disease can deteriorate quickly without their critical medications in a timely manner. This can lead to an increased length of duration of hospital admissions and an increase in both morbidity and mortality. As a result, the Parkinson's Excellence Network recommends time critical medications must be given within 30 minutes of when they are due. Over a 24 month period, we aim to identify the barriers to this recommendation being achieved within ambulatory services such as frailty same day emergency care (FSDEC) and implement interventions to come closer to this target.

Records for 110 patients with a Parkinson’s diagnosis who attended FSDEC within April 2024 and Oct 2025 were reviewed. This was further categorised into whether patients self-administered their medications, and the source of their referral. There were 81 patients who were streamed from the Emergency Department (ED), and unable to self-administer. We measured the length of time from presentation and the clerking documentation to prescription time, and the length of time from prescription until administration. We subsequently held educational interventions for the MDT, and those working in the Emergency Department. Following these, we reviewed the records of 16 patients with a Parkinson’s diagnosis who could not self-administer, and attended FSDEC from ED within December 2025 and April 2026. We compared the data collected for the three aforementioned metrics.

Our second cycle demonstrated a reduction in the mean and median length of time from presentation until prescription, and a more notable improvement from the clerking documentation until prescription. there was also an improvement in the length of time from prescription to administration. Whilst outliers were present, this shows the educational interventions had a positive impact in all domains, in particular to the time between clerking until prescription. The sample size in the second cycle is a recognised limitation.

The results show that we successfully identified lack of education as a barrier to achieving the aforementioned Parkinson's Excellence Network recommendations. Through improved education, we have come closer to achieving this. The wider implication of this being that more training and education on time-critical medication is needed for those working in an emergency department. Our priority for future cycles is to focus on the ED triage, given the data demonstrated this was the time point with the most delay.