AUTHOR=Azmi Hooman , Cocoziello Lisa , Ruzicka Francis , Clar Elana , Pederson John Michael , Jacob Blessy , Thomas Jewell , Rocco Anthony , Bobek Mary , Pereira-Argenziano Lucy , Roth Patrick , Thomas Florian P. 

TITLE=Custom order entry for Parkinson’s medications in the hospital improves timely administration: an analysis of over 31,000 medication doses

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=Volume 15 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2023.1267067

DOI=10.3389/fnagi.2023.1267067

ISSN=1663-4365

ABSTRACT=Background
Patients with Parkinson's disease (PD) are at increased risk for hospital acquired complications.  Deviations from home medication schedules and delays in administration are major contributing factors. We had previously developed a protocol to ensure adherence to home medication schedules using "custom" ordering. In this study we are assessing the impact this order type may have on reducing delays in PD medication administration in the hospital.
Material and Methods
We reviewed 31404 orders placed for PD medications from January 2, 2016 to April 30 2021.  We evaluated the orders to determine if they were placed in a Custom format or using a default non-custom order entry. We further evaluated all orders to determine if there was a relationship with the order type and timely administration of medications.  We compared medications that were administered within 1 minute, 15 minutes, 30 minutes and 60 minutes of due times across custom orders vs non-custom default orders.  We also evaluated the relationship between ordering providers and type of orders placed as well as hospital unit and type of orders placed.
Results
14204 (45.23%) of orders were placed using a custom schedule and 17200 (54.77%) of orders were placed using non-custom defaults. The median delay was 3.06 minutes less in the custom group compared to the non-custom group and this difference was significant. The median date for custom orders was more recent than the median date for non-custom default orders, and this difference was significant.  When comparing medication administration delays in subgroups, it was 1.64 times more likely for medications to be administered within 1 minute of due time, 1.4 times more likely to be administered within 15 minutes of due time and 1.33 times more likely to be administered within 30 minutes of due time when the order type was custom compared to non custom and these findings were significant.
Conclusion
This is the largest study to date examining the effects of order entry type on timely administration of PD medications in the hospital. Orders placed using a custom schedule may help reduce delays in administration of PD medications.