INS NYC 2024 Program

Paper	Paper Session 05 Program Schedule 02/15/2024 02:15 pm - 03:45 pm Room: West Side Ballroom - Salon 1 Paper Session 05: Movement Disorders Final Abstract #3 Inpatient Medication Errors in Patients with Parkinson’s Disease: Length of Stay, Readmissions, and Mortality Scott Sperling, Cleveland Clinic, Shaker Heights, United States Jeryl Ritzi Yu, Cleveland Clinic, Cleveland, United States Claire Sonneborn, Cleveland Clinic, Cleveland, United States Olivia Hogue, Cleveland Clinic, Cleveland, United States Debolina Ghosh, Case Western Reserve University, Cleveland, United States James Liao, Cleveland Clinic, Cleveland, United States Shannon Shaffer, Cleveland Clinic, Cleveland, United States Anne Brooks, Parkinson's Foundation, Miami, United States Benjamin Walter, Cleveland Clinic, Cleveland, United States Category: Movement and Movement Disorders Keyword 1: Parkinson's disease Keyword 2: movement disorders Keyword 3: treatment outcome Objective: Up to 28% of people with Parkinson’s disease (PD) are hospitalized each year. The complexity of PD and its pharmacological treatment may contribute to high rates of inpatient medication errors, and subsequently, poor outcomes. This study examined the frequency of administered contraindicated medications and medication deviations between patients’ home and inpatient medication regimens and their associated outcomes. Participants and Methods: We examined the records of 492 patients with PD who had 725 hospital admissions during a 12-month period at the Cleveland Clinic Main and Fairview campuses. We compared patients’ home medication regimens with their hospital medication administration records to establish rates of deviations in levodopa equivalent daily doses (LEDD) and the omission of time-critical medications, substitution of levodopa compounds, and administration of contraindicated medications. We used logistic regression analyses to examine the associations between medication deviations and length of stay (LOS), readmission rates, and mortality. Results: An LEDD deviation occurred in 68% of hospital admissions and 43% of hospital days. Nineteen percent of patients had a levodopa formulation substitution and 22% missed at least one levodopa dose. Contraindicated medications were administered during 10% of admissions. An LEDD underdose was associated with 78% higher odds of 30-day readmission/death (OR 1.78, 95% CI 1.08-2.93, p=0.025) and every additional day with an underdose was associated with 14% higher odds of 90-day mortality (OR 1.14, 95% CI 1.05-1.24, p=.002). The administration of contraindicated medications was associated with 85% higher odds of 30-day readmission/death (OR 1.85, 95% CI 1.02-3.45, p=0.041) and over two-fold odds of 90-day mortality (OR 2.2, 95% CI 1.2-4.3, p=0.018). LOS was associated with LEDD overdose (median 6.5 vs 4.1 days) and the administration of contraindicated medications (median 7.6 vs 3.8 days; both p<0.0001). Conclusions: Deviations between patients’ home and inpatient medication regimens, and the administration of contraindicated medications, were common in patients with PD. LEDD underdosing and the administration of contraindicated medications were associated with significantly increased LOS and increased odds of 30-day readmission/death and 90-day mortality. The development and implementation of inpatient education and intervention programs are needed to improve care and critical health outcomes for people with PD.

Paper

02/15/2024
02:15 pm - 03:45 pm
Room: West Side Ballroom - Salon 1

Paper Session 05: Movement Disorders

Final Abstract #3

Inpatient Medication Errors in Patients with Parkinson’s Disease: Length of Stay, Readmissions, and Mortality

Scott Sperling, Cleveland Clinic, Shaker Heights, United States
Jeryl Ritzi Yu, Cleveland Clinic, Cleveland, United States
Claire Sonneborn, Cleveland Clinic, Cleveland, United States
Olivia Hogue, Cleveland Clinic, Cleveland, United States
Debolina Ghosh, Case Western Reserve University, Cleveland, United States
James Liao, Cleveland Clinic, Cleveland, United States
Shannon Shaffer, Cleveland Clinic, Cleveland, United States
Anne Brooks, Parkinson's Foundation, Miami, United States
Benjamin Walter, Cleveland Clinic, Cleveland, United States

Category: Movement and Movement Disorders

Keyword 1: Parkinson's disease
Keyword 2: movement disorders
Keyword 3: treatment outcome

Objective:

Up to 28% of people with Parkinson’s disease (PD) are hospitalized each year. The complexity of PD and its pharmacological treatment may contribute to high rates of inpatient medication errors, and subsequently, poor outcomes. This study examined the frequency of administered contraindicated medications and medication deviations between patients’ home and inpatient medication regimens and their associated outcomes.

Participants and Methods:

We examined the records of 492 patients with PD who had 725 hospital admissions during a 12-month period at the Cleveland Clinic Main and Fairview campuses. We compared patients’ home medication regimens with their hospital medication administration records to establish rates of deviations in levodopa equivalent daily doses (LEDD) and the omission of time-critical medications, substitution of levodopa compounds, and administration of contraindicated medications. We used logistic regression analyses to examine the associations between medication deviations and length of stay (LOS), readmission rates, and mortality.

Results:

An LEDD deviation occurred in 68% of hospital admissions and 43% of hospital days. Nineteen percent of patients had a levodopa formulation substitution and 22% missed at least one levodopa dose. Contraindicated medications were administered during 10% of admissions. An LEDD underdose was associated with 78% higher odds of 30-day readmission/death (OR 1.78, 95% CI 1.08-2.93, p=0.025) and every additional day with an underdose was associated with 14% higher odds of 90-day mortality (OR 1.14, 95% CI 1.05-1.24, p=.002). The administration of contraindicated medications was associated with 85% higher odds of 30-day readmission/death (OR 1.85, 95% CI 1.02-3.45, p=0.041) and over two-fold odds of 90-day mortality (OR 2.2, 95% CI 1.2-4.3, p=0.018). LOS was associated with LEDD overdose (median 6.5 vs 4.1 days) and the administration of contraindicated medications (median 7.6 vs 3.8 days; both p<0.0001).

Conclusions:

Deviations between patients’ home and inpatient medication regimens, and the administration of contraindicated medications, were common in patients with PD. LEDD underdosing and the administration of contraindicated medications were associated with significantly increased LOS and increased odds of 30-day readmission/death and 90-day mortality. The development and implementation of inpatient education and intervention programs are needed to improve care and critical health outcomes for people with PD.