Hospital Care Standards Help Patients with Parkinson’s Avoid Harm

A new commentary article published by the Parkinson’s Foundation (Miami, FL) provides recommendations and standards for avoiding preventable harm incurred during hospital care for patients with Parkinson disease (PD). The authors discuss data characterizing the disproportionate rates of preventable harm sustained by patients with PD in the acute care setting, which include:

• Aspiration pneumonia causing 70% of deaths among patients with PD
• 28.3% of patients experiencing deterioration of motor symptoms
• A rate of readmittance to the hospital within 1 year of discharge of 50.8% for patients with PD
• 62.9% of patients being discharged to another facility rather than home

The article, which was published in The Joint Commission Journal on Quality and Patient Safety, draws upon and reaffirms the 5 hospital care standards comprising the Parkinson’s Foundation Hospital Care Recommendations, which were developed in 2023 by an expert panel of physicians, nurses, pharmacists, informaticists, quality leaders, speech-language pathologists, and physical and occupational therapists. These standards include:

• Custom ordering of PD medications according to patient’s at-home regimens
• Administration of PD medications within 15 minutes of patients’ at-home schedules, 100% of the time
• Elimination of potentially harmful medication events, particularly those associated with dopamine-blocking medications
• Mobilization of PD patients 3 times daily when clinically appropriate
• Screening for dysphagia within 24 hours of hospital admission to minimize risk of aspiration pneumonia

According to the authors, recent evidence demonstrates that the implementation of these standards is associated with improved outcomes for patients with PD. However, the authors note that implementation is limited by knowledge and resource constraints. For example, the authors state that 70% of hospital staff are unaware that certain medications can worsen motor symptoms or are contraindicated for people with PD.

"This article reveals that we have a fundamental obligation to ensure that the patients facing the greatest risk in the hospital are safe, such as those with PD who face disproportionate rates of preventable and unintended harm," said Peter Pronovost, MD, PhD, FCCM, lead author and Chief Quality and Transformation Officer at University Hospitals Cleveland Medical Center. "For patients living with Parkinson's, the Recommendations represent an invaluable, practical care model for all hospitals and health systems."