Audit and awareness - how staff at Hexham General Hospital improved the delivery of time critical medication: best practice case study

Why did you work to improve the delivery of time critical Parkinson’s medication for your patients?

My dissertation was based on a service improvement initiative designed to improve the delivery of Parkinson's medication on time, every time.

While I was working on my dissertation, I recognised that patients with Parkinson's receive sub optimal care while they're in hospital, an area that the National Institute of Health and Care Excellence (NICE) admits is underdeveloped. I found that patients didn't always receive their Parkinson's medication on time, and only 60% of consultants said they were confident that their patients received their medication on time.

Medication delays can cause a huge amount of unnecessary distress and anxiety for both patients and their family members. Further research highlighted there is a strong link between lack of staff education and lack of readily available medication.

Administration of Parkinson's medication on time is essential for effective management of the condition. If patients with Parkinson’s don't receive medication on time, it can have adverse health implications, impacting patient’s activities of daily living, and even leading to death.

There is evidence to suggest that patients with Parkinson’s may not make a full recovery after discharge. This is an alarming discovery when patients are in the care of healthcare professionals who are regarded as experts.

Finally, my research identified a significant correlation between delayed, missed or omitted medication and prolonged hospital admissions and increased NHS costs.

What have you done to improve the delivery of time critical Parkinson’s medication?

I introduced an awareness campaign, using a display board at the entrance to our ward for staff, patients and visitors. I hoped this would provide a learning opportunity for staff to reduce medication errors in people with Parkinson’s. 

Weekly staff meetings gave me the opportunity to raise awareness, highlight concerns and update colleagues on new strategies. I also distributed information, including the Excellence Network's "Caring for your patients with Parkinson's" booklet.

Alongside this, we initiated the use of visual prompts, such as the laminated clocks that nursing staff can mark dose times on. Using the free Parkinson’s UK resources, I provided ‘grab bags’ which we gave to people with Parkinson’s when they were discharged. This included the "Going into hospital" booklet, a medication card, Get It On Time stickers and laminated clock, to help them feel better prepared for any future admissions. 

We encouraged patients to keep spare Parkinson's medication inside the bags and asked them to bring these with them if admitted to hospital or coming to an appointment. The bag would be a visual prompt for healthcare professionals to help them identify people with Parkinson’s early and avoid missing Parkinson's doses.

The study took place over 6 months from August 2023 to February 2024. I extracted data from our electronic prescribing system (Triscribe) to explore the number of doses scheduled and compared this to the time the dose was administered: on time, early, late or omitted. This established if the service improvement intervention had made a difference and if it had improved the delivery of Parkinson's medication on time.