Quality statement 4: Levodopa in hospital or a care home

Quality statement

Adults with Parkinson's disease who are in hospital or a care home take levodopa within 30 minutes of their individually prescribed administration time.

Rationale

Serious complications can develop if levodopa is not taken on time. These include acute akinesia and, if delays are significant, neuroleptic malignant syndrome. These complications can lead to increased care needs and increased length of stay in hospital or a care home.

Quality measures

Structure

a) Evidence of local processes to accurately document administration times for levodopa for adults with Parkinson's disease on admission to hospital or a care home to reflect timings before admission.

Data source: Local data collection, for example, service protocol.

b) Evidence of local processes to identify missed, early or late administration of levodopa for adults with Parkinson's disease in hospital or a care home.

Data source: Local data collection, for example, service protocol.

Process

a) Proportion of prescribed doses of levodopa for adults with Parkinson's disease in hospital or a care home that were missed.

Numerator – the number in the denominator that were missed.

Denominator – the number of prescribed doses of levodopa for adults with Parkinson's disease in hospital or a care home.

Data source: Local data collection, for example, audit of medicines administration records.

b) Proportion of doses of levodopa for adults with Parkinson's disease in hospital or a care home that were given more than 30 minutes before the individually prescribed administration time.

Numerator – the number in the denominator that were given more than 30 minutes before the individually prescribed administration time.

Denominator – the number of doses of levodopa for adults with Parkinson's disease in hospital or a care home.

Data source: Local data collection, for example, audit of medicines administration records.

c) Proportion of doses of levodopa for adults with Parkinson's disease in hospital or a care home that were given more than 30 minutes after the individually prescribed administration time.

Numerator – the number in the denominator that were given more than 30 minutes after the individually prescribed administration time.

Denominator – the number of doses of levodopa for adults with Parkinson's disease in hospital or a care home.

Data source: Local data collection, for example, audit of medicines administration records.

Outcome

a) Patient safety incidents related to medicines for adults with Parkinson's disease in hospital or a care home.

Data source: Local data collection, for example, local records of patient safety incidents.

b) Length of hospital stay for adults with Parkinson's disease.

Data source: Local data collection. National data can be collected from NHS Digital's Hospital Episode Statistics.

What the quality statement means for different audiences

Service providers (hospitals and care homes) ensure that adults with Parkinson's disease are identified on admission so that their requirements for levodopa can be accurately identified and monitored to reflect timings before admission. This should include an assessment of self-medication. Providers should ensure that staff are trained to understand the importance of taking levodopa at the appropriate times, and to report any medicines-related patient safety incidents.

Health and social care practitioners (such as doctors, nurses, pharmacists, and care home managers and staff) ensure that adults with Parkinson's disease have an accurate medicines chart that reflects timings for levodopa before admission. Practitioners should support adults with Parkinson's disease to take levodopa on time, which may include self-medication. Practitioners should report any medicines-related patient safety incidents for adults with Parkinson's disease.

Commissioners (such as clinical commissioning groups and local authorities) commission services that ensure timings of administration for levodopa are accurately identified and monitored for adults with Parkinson's disease. There are examples where commissioners have used local CQUINs to ensure that levodopa is given on time and not missed for adults with Parkinson's disease.

Adults with Parkinson's disease who are admitted to hospital or a care home know that they need to take their levodopa medicine on time and are supported to do so. This will ensure that they do not develop complications that can happen when this medicine is not taken at the right time.

Source guidance

Parkinson's disease in adults (2017) NICE guideline NG71, recommendations 1.3.2 and 1.3.4 [the timeframe of 30 minutes is based on consensus of expert opinion]

Definitions of terms used in this quality statement

Individually prescribed administration time

The time that the person routinely takes their levodopa medicine. This should be in line with timings before admission and their individual prescription. Timings should only be adjusted after discussion with a specialist in managing Parkinson's disease.

[NICE's guideline on Parkinson's disease in adults, recommendation 1.3.2 and expert opinion]