Background Patients with Parkinson’s disease (PD) may have an unsafe swallow and unreliable absorption of oral dopamine therapy when dying. First line symptom management medication have anti-dopaminergic activity. Transdermal dopamine replacement, rotigotine, may cause delirium.
Aims To understand prescribing practice for patients with PD at end of life in an acute hospital.
• dopamine replacement therapy
• adjustments to treatment where signs of rigidity or symptoms and signs of delirium
• medication use in symptom management.
Methods Deaths where PD/atypical PD entered on medical certificate of cause of death (MCCD) were collated in a 12-month period 2021.22. A data collection form was tested and refined. A convenience sample of deaths (60%) was selected. Electronic patient records were reviewed, anonymised data collected and stored on secure NHS drives. Data was analysed by all authors. Ethics permission was not sought as the survey examined routine clinical practice.
Results 55 patients had PD/atypical PD on their MCCD over a 12-month period, 2% of all adult inpatient deaths. 31 patients had idiopathic PD, 1 Multisystems atrophy and 1 Progressive Supranuclear Palsy in the sample. The severity of PD was mixed. 79% were recognised to be approaching the end of life. Where death was expected, 7 were prescribed orodispersible dopamine replacement therapy, 20 transdermal therapy, all had dopamine replacement therapy. No prescription was adjusted, though agitation and/or delirium noted in 50% of patients. Anticipatory medications with anti-dopaminergic activity were prescribed in 58% of expected deaths and in 50% where death was not expected. Where death was expected, advice was sought from palliative care (79% patients), inpatient PD specialist nurse (7%) and neurologists (4%).
Conclusion Prescribing practice in patients dying with PD needs improvement. Prescribing guidelines were disseminated locally and educational content developed to improve practice.
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