Parkinson’s Excellence Network – Prospective Inpatient Medication Audit

Patient’s Hospital number Age range PD Stage

Admission Admission WardEmergency

Elective

Location of medication reconciliationDetails of areas with no med rec

Known dementia diagnosis Diagnosed delirium this admission

Medication Pre admission (tick all that apply)Levodopa Dopamine Agonist COMT inhibitor MAO-B inhibitor Acetylcholinesterase

inhibitorSinemet Ropinirole Enatacpone Rasagiline DonepezilMadopar Rotigotine Tolcapone Selegiline RivastigmineNone Pramipexole None None GalantamineMadopar dispersible

Apomorphine None

Sinemet and CR OtherMadopar and CR NoneSinemet and MadoparStalevoDetails of any other Parkinson’s medication

Medication prescribed on inpatient medication chart (not just new medication)Levodopa Dopamine Agonist COMT inhibitor MAO-B inhibitor Acetylcholinesterase

inhibitorSinemet Ropinirole Enatacpone Rasagiline DonepezilMadopar Rotigotine Tolcapone Selegiline RivastigmineNone Pramipexole None None GalantamineMadopar dispersible

Apomorphine None

Sinemet and CR OtherMadopar and CR NoneSinemet and MadoparStalevoDetails of any other Parkinson’s medication

<65 66-75 >75 Diagnosis Maintenance Complex Palliative

A&E AAU

Medical Surgical Cardio Neuro Ortho Heam/Onc CoE

A&E

AAU Medical Surgical Cardio Neuro Ortho Heam/Onc CoE Never

Yes No Yes

No

Parkinson’s Excellence Network – Prospective Inpatient Medication Audit Did prescribed inpatient medication match pre admission medication? (tick all that apply)Levodopa Dopamine Agonist COMT inhibitor MAO-B inhibitor Acetylcholinesterase inhibitorRight drug Right drug Right drug Right drug Right drugYes Yes Yes Yes YesNo No No No NoDetails of any exceptions

Right dose Right dose Right dose Right dose Right doseYes Yes Yes Yes YesNo No No No NoDetails of any exceptions

Did the prescription state the time of administration (eg numerical rather than box ticked)?Medication Yes No

Did the patient receive all Parkinson’s medication at the prescribed times?Yes Details of exceptionsGiven, but time of administration not recordedNo

Good practicePt self medicating?

Referred to PD specialist?

PD Drug alterations by Details of changes

Yes Yes PD SpecialistNo No Non PD specialistNA unable Both

No alterations

Has the patient received any medication that could worsen their Parkinson’s?Yes DetailsNoPrescribed but not yet given

Any omitted doses? (tick all that apply)Omitted Doses

NBM Medication unavailable

Patient refused

Medically withheld

Missed dose in A&E

Delay in prescription writing

Yes Yes Yes Yes Yes Yes YesNo No No No No No No

Any antipsychotics prescribed?Medication Dose New this admission?

Parkinson’s Excellence Network – Prospective Inpatient Medication Audit Any other comments/details