by Dr Ashraf Ahmed
NICE recommends that all people with PD who drive should be advised to inform the DVLA and their insurer of their condition at the time of diagnosis. Many, if not most, patients with PD continue driving. Once a patient is diagnosed they have to inform DVLA to continue driving, as well as needing to renew their licence more regularly.
Levodopa may cause sedation. If a patient feels sleepy they must not drive and wait till they feel alert. In practice this advice has quite often been forgotten and not given and if given has not been documented or communicated appropriately.
This audit was undertaken to determine whether appropriate driving advice, based on national guidelines, was given to patients with PD in OPD. Thirty-six case notes of patients seen in a PD clinic and diagnosed as PD were retrospectively analysed, using a purpose-created pro forma.
Out of the 36 patients, driving status was documented in 12 (33.3%). Off these 12 patients, 5 were documented as drivers. 9 out of 36 (25%) had a satisfactory approach to the issue of driving. Of the 5 patients documented as drivers 2/5 (40%) had their driving advice documented in the case notes, 3/5 (60%) had no documentation in the notes that advice was given, none had the advice communicated to GP in clinic letter. All patients were seen by a consultant in PD clinic. The advice was given accurately in all patients that had been advised.
The results show poor documentation in both medical notes and clinic letters, of both driving status and driving advice. There is an urgent need to improve on this. Below are the recommended actions that will be implemented, monitored and evaluated, with re-auditing in 12 months:
- Driving status and advice should be documented in clinical notes and communicated to GP
- To formulate a PD clerking pro forma with sections on driving status.
- To create a template for GP clinic letter with section on driving status/advice, to act as a prompt when dictating PD clinic letters.
- To present the findings in departmental meetings together with the action plan and timescale for implementation and re-auditing in 12 months after intervention to assess improvement.