FIGURE 1
Baseline age and gender of patients
Gender
Number of patients
Average age
Minimum age
Maximum age
F 41 80.07
66 94
48 79.04
52 93
M
89 79.52
52 94
Grand total
Nottingham University Hospitals NHS Trust
Emergency Department between 1 June 2016 and
31 July 2016.
All patients were included who had a formal
diagnosis of PD at the time of presentation to the
ED and took at least one medication directly used
to treat PD. Patients who were discharged directly
from the ED (that is, did not require an inpatient
stay) were excluded.
Patients with PD were determined by free
text search through electronic records of all
presentations between these dates. Key word
searches for any presence of ‘Parkinsons’,
‘Parkinson’s’, ‘Parkinsonsism’ ,‘Sinemet’,
‘Madopar’, ‘Co-Beneldopa’, ‘Cobeneldopa’,
‘Co Beneldopa’, ‘Co-Careldopa’, ‘Cocareldopa’,
Co Careldopa’, ‘Rotigotine’, ‘Stalevo’,
‘Amantadine’, ‘Rasagaline’ and ‘Selegeline’
FIGURE 2A
Length of ED stay
16%
53%
19%
19%
0–4 hours
4–8 hours
8–12 hours
12 hours+
FIGURE 2B
Patient co-morbidities
34%
16%
50%
1–2
3–4
5+
were included for further analysis.
Cases identified were then reviewed by a
research pharmacist and/or research ED clinician
for inclusion under the aforementioned criteria.
For all included cases, the total doses due
within ED and the first 24 hours of inpatient
admission were collected. This was determined
against expert medicines reconciliation by
inpatient pharmacists (which was regarded as
gold standard). All ED documentation (including
drug charts, temporary charts and electronic
notes) were reviewed for documentation of
medications being administered, delayed or
omitted. A lack of documentation was regarded as
an omission. Further data around deterioration of
symptoms after admission to ED, whether APMs
were prescribed in ED, and errors in prescribing
APMs were also collected.
Intervention by a pharmacist within the ED,
defined by review and confirmation of primary
drug history, supply (or prompted administration)
of medication and ward handover was also
collected for all patients. A single pharmacist was
available during the service period, working
07:30-15:30 during weekdays.
Statistical analysis was conducted using
Microsoft Excel 2010.
Results
A total of 177 patient records were returned from
the key word search, 62 patients were excluded
because they were either discharged directly from
the ED or did not wait for treatment. A further 23
patients were excluded as records indicated they
did not suffer from PD. Lastly, three patients were
excluded because complete records were
unavailable for analysis; this left a total of 89
patients who met the inclusion criteria and for
whom records were available for analysis.
Baseline characteristics (age and gender) were
approximately similar in the analysis groups
(Figure 1). A total of 84% of patients had at least
three documented co-morbidities, with 50%
having greater than five (Figure 2a and 2b).
A total of 86.5% of patients were correctly
identified within medical clerking in the ED
as having PD, and taking oral therapy for the
condition; 77.5% were actually prescribed
these APMs within the department (Figure 3).
Pharmacist intervention as outlined in the
Methods section occurred in 19 of the 89 cases
(21.3%). The mean numbers of doses required per
patient were similar in both groups.
Omitted doses
Dose omissions and delays within the ED were
considerably higher in patients who did not have
an early pharmacist intervention (Figure 4). This
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