Contraindicated Medication Use Significantly Impacts Length of Hospitalization in Parkinson Disease

Shannon Shaffer, APRN-CNP

Findings from a recent study of inpatients with Parkinson disease (PD) showed an increase in the number of hospital days when at least one contraindicated medication was administered. Above all, the study demonstrated that medication deviations or use of contraindicated medications can impact length of stay, readmissions, and morbidity following hospitalization.¹

Among 531 hospital admissions included in the analysis, 10% of hospital stays had at least one dose of contraindicated medications administrated and 19% had levodopa formulation substitutions. Using a cohort of 366 patients with PD, 13% had an unexpected hospital readmission after receiving levodopa equivalent daily dose (LEDD) deviations in 30 days and 10% died of discharge after receiving LEDD deviations or contraindicated medications within 90 days.

“The complexity of Parkinson disease, patient’s comorbid conditions, acute illness/hospitalization, and varying antiparkinsonian medication regimen makes patients vulnerable to medication deviations,” author Shannon Shaffer, APRN-CNP wrote.¹

Shaffer, a family nurse practitioner who specializes in movement disorders at the Cleveland Clinic's Center for Neurological Restoration, presented the findings at the 2nd Annual Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress, held by the PMD Alliance from June 8 to 11, 2023, in Washington, DC. In the study, Shaffer investigated the frequency and outcomes of deviations between both outpatient and inpatient medication treatments administered in patients with PD.

For the study population, Shaffer collected data from any patient who had a past medical history or problem list that included the labeled terms of "Parkinson Disease," "paralysis agitans," "Parkinsonism," and ICD 10 code G20 from an electronic health record query. Among the original data set of 925 hospital admissions from 572 patients, the final data set included 531 hospital admissions from 366 patients over the span of 1 year. This set was then analyzed for deviations based on the administration of time-critical treatments.

Data was collected from each patient's admission during 2018 on the patients' demographic data, age-adjusted Charlson Comorbidity Index, admission reason, length of stay, and discharge disposition (less than 30 day of readmission, less than 90 day mortality). Additional inpatient medication information such as the name, dose, date, and time were gathered from the electronic health record using custom Structured Query Language scripts.

The treatment data were analyzed through the use of custom R and SAS statistical software scripts in order to identify the administration of the contraindicated medications. Measures calculated included total LEDD, and the average daytime interval of levodopa treatment doses. The relationships between each medication variable and outcome of interest were assessed using logistic regression models.

Some of the most notable common issues with management of inpatient hospitalizations observed in the data included levodopa formulation substitutions and levodopa dose deviations. Shaffer also noted that time-critical medications not given in a timely manner, and contraindicated medications administered to PD patients were additional issues observed. Additionally, these results highlight the rate at which the errors were happening over the course of a year at a tertiary teaching institution.

“Forming proactive programs to combat the errors is warranted, rather than reactive measures which allows for the errors to take place first,” Shaffer noted.¹ “This can be done through different avenues: technology limitations on prescribing, education programs for nurses and attending teams that care for patients with PD, and an [advanced practice provider] lead consult team specifically for patients with PD who can monitor patients throughout their stay.”

Click here for more coverage of ATMRD 2023.

REFERENCES
1. Shaffer S. Establishing a framework for quality of inpatient care for Parkinson's disease: A study on inpatient medication administration. Presented at: ATMRD; June 9-11, 2023; Washington, DC.