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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

Effect of wrong administration of dopaminergic medications and neuroleptics on length of hospital stay (days).
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pone.0124356.g003: Effect of wrong administration of dopaminergic medications and neuroleptics on length of hospital stay (days).

Mentions: A significant difference was observed in length of stay when grouping those with a high-risk reason of hospitalization versus those with a low-risk reason, M = 1.5 SD = 0.9 vs. M = 1.2 SD = 0.9, median 5 vs. 3 days, p = 0.005. After adjusting for confounding variables such as age, gender, Charlson index score, low or high risk hospitalization, disease duration, and H&Y stage, the ANCOVA analysis revealed a significant effect of delayed or missed doses in length of hospital stay (p<0.01). Participants who had delayed or missed at least one dose stayed in the hospital longer (M = 8.2 days, SD = 8.89, median 5 days) compared to those who did not (M = 3.6 days, SD = 3.4, median 2 days). The results also showed a significant effect of contraindicated dopamine blocker use on length of hospital stay (p<0.05). Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M = 7.5 days, SD = 9.1, median 7 days) compared to those who did not, M = 5.9 days, SD = 6.8, median 4 days (Fig 3). We further analyzed how missed dopaminergic dosages could be related to in-hospital falls. A Chi square test revealed no significant difference in falls during hospitalization between those with missed dopaminergics vs. those without missing dosages, 2 vs. 4, p = 0.2. No significant differences were observed in length of stay when stratifying the population into the following groups: those with alteration in cognition versus those without alteration, M = 1.4 SD = 0.9 vs. M = 1.3 SD = 0.9, median 4 vs. 4 days, p = 0.79; those 70 years or above versus those with less than 70 years of age, M = 1.3 SD = 0.9 vs. M = 1.4 SD = 0.8, median 4 vs. 4 days, p = 0.87; and into those with 10 years or more of disease duration versus those with less duration, M = 1.3 SD = 0.9 vs. M = 1.3 SD = 0.9, median 3.5 vs. 4, p = 0.58. We also examined the distribution of patients for whom a neurologist was consulted during the hospitalization. A Pearson Chi Square test revealed that a neurologic consultation did not significantly impact whether there were delayed or missed doses of dopaminergics (p = 0.41), or whether a contraindicated dopamine blocker was given (p = 0.92).


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)

Effect of wrong administration of dopaminergic medications and neuroleptics on length of hospital stay (days).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0124356.g003: Effect of wrong administration of dopaminergic medications and neuroleptics on length of hospital stay (days).
Mentions: A significant difference was observed in length of stay when grouping those with a high-risk reason of hospitalization versus those with a low-risk reason, M = 1.5 SD = 0.9 vs. M = 1.2 SD = 0.9, median 5 vs. 3 days, p = 0.005. After adjusting for confounding variables such as age, gender, Charlson index score, low or high risk hospitalization, disease duration, and H&Y stage, the ANCOVA analysis revealed a significant effect of delayed or missed doses in length of hospital stay (p<0.01). Participants who had delayed or missed at least one dose stayed in the hospital longer (M = 8.2 days, SD = 8.89, median 5 days) compared to those who did not (M = 3.6 days, SD = 3.4, median 2 days). The results also showed a significant effect of contraindicated dopamine blocker use on length of hospital stay (p<0.05). Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M = 7.5 days, SD = 9.1, median 7 days) compared to those who did not, M = 5.9 days, SD = 6.8, median 4 days (Fig 3). We further analyzed how missed dopaminergic dosages could be related to in-hospital falls. A Chi square test revealed no significant difference in falls during hospitalization between those with missed dopaminergics vs. those without missing dosages, 2 vs. 4, p = 0.2. No significant differences were observed in length of stay when stratifying the population into the following groups: those with alteration in cognition versus those without alteration, M = 1.4 SD = 0.9 vs. M = 1.3 SD = 0.9, median 4 vs. 4 days, p = 0.79; those 70 years or above versus those with less than 70 years of age, M = 1.3 SD = 0.9 vs. M = 1.4 SD = 0.8, median 4 vs. 4 days, p = 0.87; and into those with 10 years or more of disease duration versus those with less duration, M = 1.3 SD = 0.9 vs. M = 1.3 SD = 0.9, median 3.5 vs. 4, p = 0.58. We also examined the distribution of patients for whom a neurologist was consulted during the hospitalization. A Pearson Chi Square test revealed that a neurologic consultation did not significantly impact whether there were delayed or missed doses of dopaminergics (p = 0.41), or whether a contraindicated dopamine blocker was given (p = 0.92).

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