EMERGANCY AND CRITICAL CARE
Pharmacist impact on Parkinson’s
disease-related care in the ED
A research study has shown that pharmacists have a vital role in early identification and
reconciliation of medications in Parkinson’s disease patients and this has the potential
to prevent deterioration and prevent further morbidity in this patient profile
Kunal Gohil MPharm
PGDip PGCert
Senior Clinical Pharmacist
– Emergency Department
Obiageli Ngwuocha
MBBS MRCEM
Registrar – Emergency
Department
Rasheed Ashraf Ali
FRCEM FRCS
Consultant – Emergency
Department, Nottingham
University Hospitals NHS
Trust, UK
Parkinson’s disease (PD) is a progressive mobility
disorder caused by destruction of dopaminergic
neurones within the central nervous system.
A considerable body of evidence is available that
demonstrate patients with this disease are at high
risk of complications 1,2 such as falls or collapses, 3
septic infections, 4 and dysphagia leading to
aspiration, 5 as well as high risks of deterioration
of mobility and functionality requiring secondary
care input.
Timely availability and administration of
anti-parkinson’s medications (APMs) has been
highlighted by both Parkinsons UK 6 and the
National Patient Safety Association (NPSA) 7 as
a key implementation in preventing further
morbidity in this patient group in secondary care.
EDs are acknowledged to be high risk areas for
medication error 8–10 with dose omissions of
critical medications (including APMs) being highly
prevalent. 11 Furthermore, considering the current
stress on National Health Service (NHS) EDs,
patients experience considerable waits both to
be seen and a for transfer to base ward level if
required. The Royal College of Emergency
Medicine, in a statement in 2014, explained
that around 500 deaths within EDs could be
attributable to overcrowding.
Higher-risk medical patients, including
patients with PD, have previously been found to
experience longer waiting times in the ED and
longer total inpatient stays than other patient
populations. 12
The clinical presence of pharmacists within
inpatient areas in improving quality and safety is
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HHE 2019 | hospitalhealthcare.com
now well established. 13 Pharmacists are identified
as key healthcare professionals in improving
medicines optimisation within secondary care.
Lord Carter 14 was also keen to identify the
importance for new and innovative practices
required in EDs, to support patient safety and
aid with flow.
A preliminary service evaluation 15 of a pilot
pharmacy service in the ED established the
important potential for clinical pharmacy services
to prevent dose omissions and improve safety in
patients with PD within a large teaching hospital
ED. A total of 52 ‘serious’ interventions were
recorded over the service period, specifically in
relation to APMs (8.8% of the total interventions
recorded). Further literature 16 explored the
potential benefits of clinical pharmacy services
in the ED, finding them equally effective at
improving safety and quality, as well as reducing
ED clinician workload.
This follow-on hypothesis generating study
will identify the prevalence of APM dose omission
within a large teaching hospital ED, and
determine the effect of pharmacist intervention
in the care of these patients within the
emergency department prior to admission to
the ward. We will further explore the role of
a pharmacist clinical intervention in these
patients, and aim to assess any impact on their
care, particularly in the case of missed doses.
Methods
A retrospective audit was designed, in order to
capture all patients with PD presenting to