Parkinson’s Disease Inpatient Clinical Knowledge and Management

Overview

This study will focus on patients with Parkinson's Disease in the adult inpatient units of Hackensack University Medical Center. We are measuring the effect of a Parkinson's Disease Inpatient Clinical Knowledge and Management Program on adherence to Parkinson's Disease medication using a Parkinson's Disease Identification Wrist Band, smartwatch and medication schedule card

Full Title of Study: “Parkinson’s Disease Inpatient Clinical Knowledge and Management”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Non-Randomized
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Supportive Care
    • Masking: None (Open Label)
  • Study Primary Completion Date: October 1, 2020

Detailed Description

Parkinson's Disease (PD), the second-most common neurodegenerative disorder and is ranked the fourteenth leading cause of death. PD prevalence rate in the United States is estimated to be approximately 0.3% and is ranked the fourteenth leading cause of death (CDC, 2013). Depending on the methodology, the national prevalence data on PD is varied and insufficient. PD is projected to increase by 4% to 5% in age 65 and over 85 years respectively and is associated with high economic burden exceeding $14.4 billion per year.

Admission to the hospital is identified as a major risk factor due to imprecise timing of medication administration, disruption of sleep pattern, dietary changes, and unfamiliarity of the hospital environment which all contribute to exacerbation of PD symptoms. Parkinson's disease Foundation, 2015). Hospital length of stay for patient with PD is 1.45 times higher in comparison to non- PD patients.

A study by Chou et al., (2011) involving 51 worldwide National Parkinson Foundation Centers found 94% of centers were not confident in the care and knowledge hospital professionals provided specific to: PD medications, complex drug interactions, contraindications and precise timing of medication administration. Hospital co-morbidities could be improved or prevented by adjustment of PD medication and medication adherence, critical in decreasing hospital length of stay.

The retrospective phase will be a data collection of adult patients admitted with a primary and secondary diagnosis of Parkinson's disease during January – June 2015 (6 month period). There will be 150 patients selected by the principal investigator(s) from chart review. In addition, the clinicians chosen for the study will complete a Parkinson's Disease Knowledge Assessment Survey.

The prospective phase will begin after completion of the Parkinson's Disease Inpatient Clinical Knowledge and Management Program for staff nurses, advanced practice nurses (APN), nursing assistants, patient care technicians, case managers, adult inpatient physician assistants, pharmacists, occupational therapists, physical therapists, nurse educators, and dietitians. There will be 150 patients selected from the adult inpatient units by the principal investigator(s) that meet the inclusion criteria and confirm through an informed consent that they will participate in the study.

The selected patients will be registered in a Watch Rx interface via website URL by the Principal Investigator(s) and the Transition of Care(TC) Pharmacist and required to wear a Watch Rx smartwatch for the duration of their hospitalization. The Watch Rx Interface will store all medical information, necessary treatments and daily clinical care for the patient which is synchronized to the smartwatch on the patient's wrist. The smartwatch will send alerts to the patient's assigned nurse's iPad through a Watch Rx app for medication administration, missed PD medications, battery conditions, and enables messaging between the primary nurse and the patient.

The WatchRx smartwatch will remind when it is time to take the medication. If the Parkinson's Disease medication is not administered, it sends missed medication reminder alerts to the nurse. For fixed time medication, the reminder is every 3 minutes up to 10 minutes.

During the prospective phase, the research team will collect data from multiple sources such as the Watch Rx system, EPIC Hyperspace, and Case Report forms over a 6 month study period. The data will be calculated by using statistical analysis for the continuous variables and categorical variables identified from the collection of data. All study data will be imported into SAS software where data programming will be utilized to flag and generate queries on out of range data issues until they are resolved. All analysis will be performed using SAS version 9.4 (SAS Institute Inc. Cary, NC, USA Data will be handled in a confidential manner to meet mandated IT Security standards and to prevent loss of privacy. All electronic files will be stored in an encrypted and password-protected database on a secure medical center server. Only co-investigators, advanced practice nurses and the data coordinator who contact the subjects will have access to information linked to subject identifiers.

This study will improve timely administration of medications to PD patients. Patients enrolled in the study will have direct monitoring of their medication compliance and adherence. Patients participating in the registry will be gain information from the current research and possibly create a support group amongst themselves. This study will improve knowledge of Parkinson's disease amongst clinicians and better medication management of PD patients

Interventions

  • Device: Watch Rx system
    • The Watch Rx system consists of a Watch Rx smartwatch, Watch Rx application and a WatchRx Web Interface. The Watch Rx smartwatch will be worn on the patient’s wrist. The smart watch will send alerts to the caregivers through the Watch Rx app when it is time to administer the medication. The Web Interface will be used to store the medical documentations
  • Other: Parkinson’s Disease Inpatient Clinical Knowledge and Management Program
    • Parkinson’s Disease Inpatient Clinical Knowledge and Management Program educates clinical staff and measures difference in knowledge of medication adherence and compliance for hospitalized Parkinson’s Disease patients

Arms, Groups and Cohorts

  • Experimental: Retrospective Phase
    • 150 patients with Parkinson disease before completion of the Parkinson’s Disease Inpatient Clinical Knowledge and Management Program.
  • Experimental: Prospective Phase-Watch Rx system
    • 150 patients after completion of the Parkinson’s Disease Inpatient Clinical Knowledge and Management Program who are also assigned to a WatchRx system
  • Experimental: Retrospective Phase – Clinicians
    • 346 clinicians, including physician’s assistant, advanced practice nurses, staff nurses, nurse educators, case managers, dietitians pharmacists physical therapist and occupational therapist before completion of the Parkinson’s Disease Inpatient Clinical Knowledge and Management Program.
  • Experimental: Prospective Phase – Clinicians
    • 346 clinicians, including physician’s assistant, advanced practice nurses, staff nurses, nurse educators, case managers, dietitians pharmacists physical therapist and occupational therapist after completion of the Parkinson’s Disease Inpatient Clinical Knowledge and Management Program.

Clinical Trial Outcome Measures

Primary Measures

  • Compare the Parkinson’s Disease Inpatient Clinical Knowledge of clinicians before and after the Parkinson’s Disease Inpatient Clinical Knowledge and Management Program
    • Time Frame: 1 year
    • Examine the effectiveness of Parkinson’s Disease Inpatient Clinical Knowledge and Management Program on PD medication management using a Parkinson’s Disease Knowledge Assessment Survey
  • Evaluate the Impact of WatchRx system on PD medication adherence during hospitalization
    • Time Frame: 6 months
    • Track number of medication errors as measured by difference in actual and scheduled PD medication administration time and the number of contraindicated medication administrations.
  • Track adverse events in hospitalized patients
    • Time Frame: 6 months
    • Track adverse events (including number of falls, number of falls with injury, number of patients with positive CAM/Mini-Cog scores, and length of stay) in hospitalized patients before and after implementation of Parkinson’s Disease Inpatient Clinical Knowledge and Management Program and the WatchRx system.

Secondary Measures

  • Patients with Early Identification of Parkinson’s Disease
    • Time Frame: 6 Months
    • number of patients with early identification of Parkinson’s Disease
  • Patients Enrolled in Parkinson’s Disease Registry at HackensackUMC
    • Time Frame: 6 Months
    • Parkinson’s Disease Registry
  • Trend the prevalence of Parkinson’s Disease patients at HackensackUMC
    • Time Frame: 6 Months
    • Identify a trend

Participating in This Clinical Trial

Inclusion Criteria

  • Adult patients diagnosed with primary and secondary diagnosis of Parkinson's disease
  • Patient 22 years old and older
  • Patients admitted to inpatient units
  • Patient who are verbally informed and agree to participate in the study

Exclusion Criteria

  • Patients less than or equal to 21 years of age
  • Patients who refuse to wear the PD wrist band.
  • Patients who verbally refuse enrollment in the PD registry.

Gender Eligibility: All

Minimum Age: 22 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Hackensack Meridian Health
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Azmi Hooman, MD, Principal Investigator, Hackensack Meridian Health
    • Mohammed Quadri, MD, MBA, Principal Investigator, Hackensack Meridian Health
    • Claudia Douglas, DNP, Principal Investigator, Hackensack Meridian Health

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