Parkinson's disease is a common and complex neurodegenerative condition. Sadly, through Datix reporting of incidents we know there are shortfalls in the quality of care for inpatients with Parkinson's disease who are admitted non-electively. This is largely due to the lack of understanding of the complex requirements of patients with Parkinson’s and particularly the importance of getting medication on time.
In this Q&A Practice Development Nurse Jess Cooke talks about how her experience treating those with Parkinson’s motivated her to improve how we care for people with the condition at The Countess.
What prompted you to look at how patients with Parkinson’s are managed in the hospital?
In May 2015 I read a complaint from a family who were unhappy with the care their father had received as an inpatient following an emergency admission. The gentleman had Parkinson’s disease and the complaint centred on the poor management of his condition in respect to medication being administered on time. The complaint was a difficult read and it was obvious the poor management was due to a lack of understanding; as a Practice Development Nurse I felt a responsibility to raise awareness of the disease, and in particular, the detrimental effect not getting medication on time can have on their recovery. Having previously worked on a care of the elderly ward, I was already passionate about Parkinson’s and acutely aware that the number of patients with the condition is on the rise and that as a hospital we are seeing more patients with the condition in an in-patient setting. Ensuring staff have the knowledge to look after them struck me as being a priority.
Where did you start?
I knew improving the knowledge around Parkinson’s was going to be a challenge. I had not long started on the AQuA introduction to improvement programme, which introduces you to the fundamentals and concepts of quality improvement and with the support of my manager Ruth Millward and the teachings of the course I knew it was possible for me to make changes, I just had to use SMART objectives and start with a pilot to ensure the process would work.
I started by reviewing incidents involving Parkinson’s patients and I found that AMU and A&E had the highest number of these incidents, and in similar vein to the complaint I had been given, they were largely to do with the administration of medications. With this information I decided to use AMU as my pilot ward. With the help of the Clinical Audit Team, I completed an audit which looked at Parkinson’s awareness on AMU in December 2015. The audit results indicated that only 25% of band 5 & 6 staff nurses on AMU felt they have a good understanding of Parkinson’s disease, and only 50% were aware of the ‘Get it on Time’ Campaign.
Did the audit results come as a surprise to you?
No, as nurses we strive to do the best for our patients and the audit reflected the fact that the high incident of complaints was because the staff didn’t have the knowledge or understanding of the complexity of Parkinson’s medications, they weren’t intentionally giving poor patient care.
What did you do following the audit?
After completing the audit, I decided to contact the Parkinson’s society for more information about resources available for educating staff and raising awareness; I was put in contact with their education advisor and with her help I arranged for a staff nurse from AMU to complete an online module in Parkinson’s disease – that staff nurse is now a ‘Parkinson’s Champion’ and is responsible for disseminating her learning and raising awareness of the ‘Get it on Time’ campaign through safety briefs.
What is the benefit of having a Parkinson’s champion on AMU?
Having someone who is dedicated to ensuring staff are educated on Parkinson’s ensures that when patients are admitted they receive the best possible care.
You’ve mentioned the ‘Get it on time’ campaign, what is this?
To stop their condition getting out of control, people with Parkinson’s need their medication on time – every time. If a person with Parkinson’s does not take their prescribed medication at the right time, the balance of chemicals in their bodies can be severely disrupted – and this will lead to their Parkinson’s becoming uncontrolled. This can lead to a person having a sudden loss of movement, sleep disturbances, impaired bowel and kidney function, digestive problems and mood swings may also be triggered. Once this balance of chemicals has been upset it may take hours, days or even weeks for a person’s Parkinson’s to stabilise – this has a detrimental effect on the length of hospital stay as their ability to recover is impaired. In the case of the original complaint I received, the gentleman was unable to swallow medications and was so agitated he had to be sedated for a CT scan. Hopefully, because of the work we have done to raise awareness of the importance of getting medication on time, incidents such as this will become a thing of the past.
To facilitate the highlighting of patients with Parkinson’s the Parkinson’s society provide a wealth of resources for the campaign, including yellow ‘Get it on time’ stickers which are used to ensure Parkinson’s patients are easily identified on the ward.
So what is next?
The appointing of a Parkinson’s champion and implementation of the ‘Get it on time’ campaign has proved to be a success on AMU; there has been a significant decrease in Parkinson’s medication related incidents. We already have Parkinson’s champions on a further two wards – the next step is to have one on every ward within a year.
Jess will be running a stand on Parkinson’s outside the staff canteen on 21 April 2016. Information and materials about the ‘Get it on time’ campaign will be readily available and you will be able to talk not only to Jess, but Colin Cheesman, Chairman of the local Parkinson’s Society.