Abstract
Improving the Safety and Continuity of Care for Patients on Apomorphine: A Three-Cycle Quality Improvement Project
Cheng Khuang Lim1; Roberta Dewar1; Fern Gibbon2;Carol Miller2
Salford Care Organisation, Northern Care Alliance
Background:
Delays in the administration of dopamine agonists in patients with Parkinson’s disease can lead to serious patient safety incidents, and transitions of care are a critical period during which medication errors are especially likely to occur.
Introduction:
Apomorphine is a potent dopamine agonist used as an adjunct therapy in the management of advanced Parkinson’s disease, particularly in patients experiencing freezing episodes. It is commonly administered via continuous subcutaneous infusion, and so its management requires careful coordination at the point of discharge. A local review identified inconsistencies in discharge documentation, supply of equipment, and communication with the movement disorder team. This quality improvement project aimed to improve discharge safety and communication through the implementation of a structured checklist.
Method:
Cycle 1 involved the introduction of an apomorphine discharge checklist on Ward L5, with compliance monitored and feedback provided. In Cycle 2, further improvements included medical staff education and ensuring full stock of apomorphine equipment on the ward. In Cycle 3, the Parkinson’s Disease Nurse Specialist (PDNS) led monitoring of discharges and delivered ongoing staff training. Data was collected retrospectively across three cycles as shown in Figure 1.
Results:
Following Cycle 1, compliance improved across all three measures (0% to 100%). In Cycle 2, a single identified case showed full compliance. In Cycle 3, of six patients:
100% of patients were discharged either with an appropriate supply of apomorphine and equipment, or the pharmacist documented that the family already had a sufficient supply of all necessary medications and equipment.
33% had movement disorder team contact details documented.
83% had an identified and satisfied receiving team.
Performance dipped in Cycle 3, attributed to weekend/on-call discharges, staff turnover, and one discharge from surgical ward.
Conclusion
This quality improvement project showed that initial implementation of the checklist led to significant improvements in discharge safety for patients on apomorphine. However, sustainability proved challenging due to staffing changes and variability in ward practices. This work highlights the need for ongoing education to ensure safety in complex medication discharges.