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Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients.

Martinez-Ramirez D, Giugni JC, Little CS, Chapman JP, Ahmed B, Monari E, Wagle Shukla A, Hess CW, Okun MS - PLoS ONE (2015)

Bottom Line: A significant effect for dopaminergic administration (p<0.01) on length of hospital stay was observed.Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1) compared to those who did not (M=5.9 days, SD=6.8).These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.

ABSTRACT

Background: Parkinson's disease patients are more likely to be hospitalized, have higher rates of hospital complications, and have an increased risk of deterioration during hospitalization. Length of stay is an important underlying factor for these increased risks. We aimed to investigate potential medication errors that may occur during hospitalization and its impact on length of hospital stay.

Methods: A cross-sectional chart review of 339 consecutive hospital encounters from 212 PD subjects was performed. Medication errors were defined as wrong timing or omission of administration for dopaminergic drugs and administration of contraindicated dopamine blockers. An analysis of covariance was applied to examine whether these medication errors were related to increased length of hospital stays.

Results: A significant effect for dopaminergic administration (p<0.01) on length of hospital stay was observed. Subjects who had delayed administration or missed at least one dose stayed longer (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4). Contraindicated dopamine blocking agents were administered in 23% (71/339) of cases, and this was also significantly related to an increased length of stay (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4), p<0.05. Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1) compared to those who did not (M=5.9 days, SD=6.8). Neurologists were consulted in 24.5% of encounters. Specialty consultation had no effect on the medication related errors.

Conclusions: Missing dopaminergic dosages and administration of dopamine blockers occur frequently in hospitalized Parkinson's disease patients and this may impact length of stay. These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization.

No MeSH data available.


Related in: MedlinePlus

Levodopa delayed or missed dosages (n = 1507).
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pone.0124356.g001: Levodopa delayed or missed dosages (n = 1507).

Mentions: The data/chart review revealed a minority of subjects in which dopaminergic drugs were ordered with specific times for administration rather than just written as BID, TID, or QID (levodopa in 10.1% and dopamine agonists in 4.2%). When considering the total number of scheduled dosages in the cohort, 29.5% (1507/5,103) of levodopa and 24.2% (213/881) of dopamine agonists dosages were either delayed or missed. Specifically for levodopa (Fig 1), dosages were not administered within the expected hour in 11.1% (565/5,103), within 2 hours in 4.4% (225/5,103), within 3 hours in 4.2% (216/5,103), and dosage were completely omitted in 9.8% (501/5,103) of cases. For dopamine agonists (Fig 2), dosages were not administered within the expected hour in 8.3% (73/881), within 2 hours in 5% (44/881), within 3 hours in 3.3% (29/881), and were omitted in 7.6% (67/881). The reasons for dopaminergics being omitted was only reported in 41/568 dosages, being nil per os (i.e. an order to withhold oral intake) (27/41, 65.6%) and non-availability of medications (10/41, 24.3%) as the two most common reasons for omission. The relevant independent variable of interest in the ANCOVA was whether a dose of levodopa was delayed or missed during the hospital stay or not.


Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients.

Martinez-Ramirez D, Giugni JC, Little CS, Chapman JP, Ahmed B, Monari E, Wagle Shukla A, Hess CW, Okun MS - PLoS ONE (2015)

Levodopa delayed or missed dosages (n = 1507).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4401689&req=5

pone.0124356.g001: Levodopa delayed or missed dosages (n = 1507).
Mentions: The data/chart review revealed a minority of subjects in which dopaminergic drugs were ordered with specific times for administration rather than just written as BID, TID, or QID (levodopa in 10.1% and dopamine agonists in 4.2%). When considering the total number of scheduled dosages in the cohort, 29.5% (1507/5,103) of levodopa and 24.2% (213/881) of dopamine agonists dosages were either delayed or missed. Specifically for levodopa (Fig 1), dosages were not administered within the expected hour in 11.1% (565/5,103), within 2 hours in 4.4% (225/5,103), within 3 hours in 4.2% (216/5,103), and dosage were completely omitted in 9.8% (501/5,103) of cases. For dopamine agonists (Fig 2), dosages were not administered within the expected hour in 8.3% (73/881), within 2 hours in 5% (44/881), within 3 hours in 3.3% (29/881), and were omitted in 7.6% (67/881). The reasons for dopaminergics being omitted was only reported in 41/568 dosages, being nil per os (i.e. an order to withhold oral intake) (27/41, 65.6%) and non-availability of medications (10/41, 24.3%) as the two most common reasons for omission. The relevant independent variable of interest in the ANCOVA was whether a dose of levodopa was delayed or missed during the hospital stay or not.

Bottom Line: A significant effect for dopaminergic administration (p<0.01) on length of hospital stay was observed.Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1) compared to those who did not (M=5.9 days, SD=6.8).These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Florida College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America.

ABSTRACT

Background: Parkinson's disease patients are more likely to be hospitalized, have higher rates of hospital complications, and have an increased risk of deterioration during hospitalization. Length of stay is an important underlying factor for these increased risks. We aimed to investigate potential medication errors that may occur during hospitalization and its impact on length of hospital stay.

Methods: A cross-sectional chart review of 339 consecutive hospital encounters from 212 PD subjects was performed. Medication errors were defined as wrong timing or omission of administration for dopaminergic drugs and administration of contraindicated dopamine blockers. An analysis of covariance was applied to examine whether these medication errors were related to increased length of hospital stays.

Results: A significant effect for dopaminergic administration (p<0.01) on length of hospital stay was observed. Subjects who had delayed administration or missed at least one dose stayed longer (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4). Contraindicated dopamine blocking agents were administered in 23% (71/339) of cases, and this was also significantly related to an increased length of stay (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4), p<0.05. Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1) compared to those who did not (M=5.9 days, SD=6.8). Neurologists were consulted in 24.5% of encounters. Specialty consultation had no effect on the medication related errors.

Conclusions: Missing dopaminergic dosages and administration of dopamine blockers occur frequently in hospitalized Parkinson's disease patients and this may impact length of stay. These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization.

No MeSH data available.


Related in: MedlinePlus