3667 A multi-cycle audit aimed at improving prescribing for patients dying with Parkinson’s disease: still room for improvement

Abstract Introduction Caring for patients with Parkinson’s disease (PD) approaching end of life (EoL) is challenging. A switch to transdermal rotigotine for dopamine therapy due to loss of an oral route can lead to delirium/agitation and several first-line symptom management medications used at EoL have anti-dopaminergic activity. Aims To analyse and improve prescribing for patients with PD at EoL in an acute hospital setting, focusing on: Dopamine replacement therapy Symptom management. Methods Deaths where PD was entered on the medical certificate of cause of death (MCCD) were collated in 3 rounds of minimum 3 months duration spanning February 2021 to March 2024. After round 1 a new ‘medicines information leaflet’ relating to prescribing for patients dying with PD was introduced. After round 2 a new prescribing ‘PowerPlan’ for EoL symptom management in PD was added to the electronic prescribing system. Patient records were reviewed retrospectively and anonymised data stored on secure NHS drives. Ethics permission was not sought as this audit examined routine clinical practice. Results A total of 74 patients had PD on their MCCD over the 3 rounds of data collection. The vast majority (84%) had idiopathic PD. Patients were most frequently admitted taking oral co-beneldopa and/or co-careldopa. Across the 3 rounds, 41% of PD patients recognised to be dying were prescribed rotigotine patches. Comments on patient agitation were found in 38% of patients’ records (52%, 33% and 42% respectively). Corresponding dose adjustments to rotigotine patches were made in just 3 cases. Anti-dopaminergic medications were prescribed for 47% of patients recognised as dying in round 1. This dropped to 7% of patients in round 2 but remained essentially unchanged from pre-intervention levels in round 3 at 50%. Conclusion Despite several targeted interventions, there remains scope for improvement in prescribing for patients with PD who are recognised to be dying.