Objective:

We sought to reduce prescription of contraindicated medications to hospitalized people with Parkinson’s disease (PD).

Background:

Hospitalization is common in PD and associated with significant morbidity and mortality.  We implemented targeted interventions to reduce contraindicated medications.

Design/Methods:

We implemented a staged intervention with multidisciplinary input (nursing administration, pharmacy, rehabilitative therapy, Parkinson center coordinator, movement disorder neurology, medical informatics, and hospital outcomes professionals). We strategized how to identify PD patients in our system, where they were commonly under non-neurologist care. We utilized the electronic medical record (EMR) to activate a drug-drug interaction (DDI) pop-up that would flag possible contraindication when a neuroleptic was prescribed to a person who was prescribed PD medication. This went live Nov. 2023. The next year, in Sept. 2024, we launched a best practice advisory (BPA) so that any time PD medications were ordered, an alert asked if the patient has parkinsonism. The prescriber could click to add to the problem list, or could decline. We assessed the impact of each intervention on reducing unsafe medication events. 

Results:

We analyzed 555 encounters from 2023 (all available data prior to the DDI warning, spanning 10mo) and found that on average 23.70% of patients received contraindicated medications. Subsequently, we assessed 301 encounters from 2024 (after DDI, but before BPA, spanning 6mo) and saw reduction to 15.89%. Finally, 373 encounters from 2025 (after DDI + BPA, all available data at the time of submission, 7mo) were analyzed, and found further reduction to 12.22%. The drug-drug interaction warning (agnostic to diagnosis) reduced “bad drug” prescription by 33%, and the BPA reduced that number by another 23%. Together, the interventions improved (reduced) contraindicated medication prescription by 48.4%. 

Conclusions:

Incremental strategies using the EMR had cumulative benefits in reducing unsafe medications, cutting contraindicated prescriptions nearly in half. Widespread educational strategies are planned to further improve PD treatment.