Improving care for people with Parkinson’s disease presenting to an Emergency Department: Implementing a care bundle

Prof. Margaret Fry1,3, Mrs Marion Harris2

1University of Technology Sydney, Broadway, Australia, 2Hornsby Hospital NSLHD, Hornsby , Australia, 3Northern Sydney Local Health District, Royal North Shore Hospital, Australia

Introduction:  Hospital presentations to the Emergency Department (ED) can be traumatic for people with Parkinson’s disease (PD) due to the complexity of clinical management and medication regimens and the potential side effects. As a result care can be compromised if not coordinated well, medication regimens are not maintained and or inappropriate prescribing of PD medicines.

Method:  This was a study evaluating the implementation of a care in one Sydney ED. The evaluation involved a pre-post medication record audit, patient interviews and nurse surveys. The care bundle included a: clinical pathway, education program and a learning package, electronic medical record prompt, patient sticker for the medical record, multidisciplinary involvement and clinician electronic alerts, and ED based PD medications.

Results: The pre-post medication audit identified a 13% improvement in the correct prescription of PD medications, although this was not statistically significant (X2 2.101df 2 p=.147).  There was a 21% improvement in timely PD administration in the pre-post audit which was statistically significant (X2 4.024 df 2 p=.041). Twenty-nine patient telephone interviews were conducted with the majority male (n=22, 76%), average age 78years, living in their own home (n=11 38%), with a PD disease duration 7.1years. ED nursing knowledge survey response rate was 51% (n=30).  The majority (n= 25; 84%) of respondents were female with a median of 9.3 years nursing experience and 5 years ED experience. Post care bundle implementation identified improvement in pharmacy alerts (100%) and reviews (76%), medication documentation (94%) and PD sticker usage (74%).

Conclusion: Implementation of the ED care bundle has led to early identification of patients with PD, improved medication regimens, increased nursing knowledge, multidisciplinary engagement, improved documentation, and consistency in pathway adherence, improved patient satisfaction, and access to PD information.


Professor Fry is Director of Research and Practice Development for Northern Sydney Local Health District and holds a Professorial Chair position with the University of Technology Sydney. Professor Fry has a strong emergency care background, has held CNC positions and is an authorised Nurse Practitioner (NSW). Professor Fry has extensive senior nursing experience and a proven research track with 118 peer reviewed publications and over $2.2million in grant, research tenders and or scholarship funding.