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Macquarie Care Centre, NSW

Optimal timing of medication for Parkinson's disease

In order to increase the knowledge and understanding of medication administration times and staff practices, the facility staff undertook research into best practice in realtion to administration of medicines associated with Parkinson's disease. The following steps were taken:

  • a joint meeting of the medication administration team to discuss and develop a common understanding of Parkinson's disease and the current medications used
  • education of all concerned in relation to Parkinson's disease including stages of the disease, prognosis, treatments and medication management
  • consultation and collaboration with neurologist to assist in the above processes and the understanding of the impact of medicines and required administration practices in relation to the health outcome of the resident
  • research and validation of what is considered to be best practice in relation to administration of this medication group. Emphasis was placed on the medications themselves, combination of administered drugs and the methods of administration.
  • review the timing of medication administration in line with a specific drug area - Parkinson's disease medications
  • review of residents currently being administered the medications and review of their drug charts. This formed the baseline information, eg. how many residents being admimnistered the medications/administration techniques/time effectiveness and administration
  • review of the findings by the medication administration team and ongoing reflection and evaluation of project outcomes
  • remeasuring of practices using the same audit methodology and evaluation of timing of administration practices.

The findings

A number of discoveries were made about the impact of medication administration practices and medication timing on the health outcomes for the resident with Parkinson's disease. Our discoveries included:

  • The goal of the medicine treatment is to use the least amount of medication to enable the resident to keep functioning and have quality of life.
  • The treatment regimen should be individualised to the resident eg. activity, cognitive decline, predominant symptoms etc.
  • Medications used are not a cure nor do they slow the progress of the disease.
  • Medication absorption is affected by diarrhoea.
  • About the medicines used for Parkinson's disease:
  • They are effective through all stages of the disease, however medication timing becomes harder to manage as the disease progresses.
  • Late in the disease the timing of the medication is critical.
  • While a younger person can store the medication in their body and access when required, an older person does not store the medication and requires it at the most optimal time to treat their symptoms.
  • Focus on the needs of the individual resident - assessing their life style and giving the Parkinson's disease medications at the optimal time to achieve their goals.
  • Interactions with other medications may have a profound effect on lowering blood pressure.
  • Practical information about the administration practies of the medicines associated with Parkinson's Disease. This included:
  • Protein reduces the effect of the medications, therefore medications should not be given with food or supplements such as two cal, ensure etc.
  • Some effect of the medication should be seen after 15 minutes following administration.
  • Crushing tablets will cause a more rapid onset: 15-20 minutes rather than 30 to 45 minutes.
  • About the timing of administration of medicines associated with Parkinson's disease:
  • Treat the dose and timing of Parkinson's disease medication with the same diligence as that of insulin or S8 drugs.
  • Levodopa should always be administered at the same time each day and in the same way with respect to food.
  • Never cease abruptly.
  • Medication given at 1130 hours may stabilise a person by 1400 hours.
  • Varying administration times by even half an hour can impact on the outcome of the medicine.
  • Encourage medical practitioners to allow flexibility in the timing of Parkinson's disease medications and in ordering PRN medications.

The outcomes

  • Flexible timing for administration medicines to support the therapeutic effect of the medicine
  • Improved quality of life for individual residents by individualising administration times
  • Scheduled regular meetings of registered nurses and enrolled nurses to case study the timing of medicine administration for individual residents
  • Increased alertness to and monitoring of clinical issues which impact on the effect of medicines, eg. incidences of diarrhoea.

Where to from here?

Researching other medicines for specific disease management and looking at how they are affected by administration times, just as we discovered with the drugs used for Parkinson's Disease. The findings of this project will be used to look at other medicines and the way they are administered and scheduled.