by Dr James Fisher
If you look after people with Parkinson’s disease (PD) you’ll know that sometimes medication administration in hospital is not as good as it could be. Things can get particularly challenging when patients are unable to take their usual tablets due to swallowing difficulties or being made nil by mouth (NBM). Missing PD medications is risky – not only will patients’ symptoms get worse, but abrupt withdrawal is associated with the rare, but potentially fatal, neuroleptic malignant syndrome. PD specialist nurses provide an invaluable source of help and guidance for such situations, but swallowing problems overnight, or at weekends, may mean medical and nursing staff do not have a source of guidance for how to manage the medications.
The Northumbria Healthcare NHS Foundation Trust PD service developed an online medication conversion tool to help with this scenario: pdmedcalc.co.uk. The tool simply asks you to enter the patient’s usual medications, before calculating the equivalent doses of dispersible madopar for administration via a naso-gastric or ‘PEG’ tube. The tool also provides a suggested rotigotine patch dose, for situations where transdermal delivery of replacement medication may be more appropriate.
As part of my project for the recent 29th Advanced Parkinson’s MasterClass I undertook an evaluation of user experience of the tool, in the hope that the insights derived from this could improve future iterations of the tool. A synthesis of website hosting data and an online survey was used to gather a mix of quantitative and qualitative data from users of the tool.
Since its launch the tool has been accessed over 3,000 times. Survey data suggests that the tool has been used predominantly by pharmacists and senior medical staff. Survey respondents overwhelmingly reported that entering the medications, and interpreting the results the tool provided, was easy. Free-text feedback returned by survey respondents provided valuable insight into the user experience. In light of this, changes were made to the user interface, additions and modifications were made to explanatory text within the tool and active web links were incorporated to facilitate access to the references that underpinned the tool’s calculator algorithm.
We’re keen for the use of the tool to become more widespread and a number of initiatives will hopefully facilitate this. Firstly, in the Northeast and Cumbria, pdmedcalc.co.uk has been incorporated into the Parkinson’s Excellence Network’s regional guidelines for PD patients who are NBM. Secondly, an article that describes in more detail how the tool was conceived and developed will be published in the Royal College of Physicians’ Future Hospitals Journal in 2017. Lastly, we would be most grateful for your help in spreading the word. We hope you find this to be a useful tool in the clinical workplace – if so, please do tell a colleague about it. Alternatively, if you have any suggestions about how we might further improve it, please do get in touch.