Studies have demonstrated that 21-43% of hospitalized PD patients have received dopamine antagonists, leading to complications and longer hospital stays. The AAN has compiled a list of medications that should be avoided in PD.

In a retrospective chart review, we identified all PD patients who were hospitalized or seen in the University of Colorado ED from July 1, 2019 to June 30, 2020 for baseline data. We calculated the proportion of these patients who received contraindicated medications. With stakeholder input from movement disorder neurologists, surgeons, pharmacists, inpatient physicians, emergency department (ED) physicians, and electronic medical record (EMR) analysts, we developed an EMR best practice alert (BPA) that was launched on December 8, 2020. The BPA is triggered when a patient with a diagnosis of PD is prescribed a dopamine-blocking medication. We collected data on BPA use and the number of PD patients who received contraindicated medications in the 12 months after the BPA was launched.

At baseline, 19.3% of PD patients at the University of Colorado received at least one dose of a contraindicated medication. In the first 3 months after BPA deployment, 139 PD patients were seen in the ED or admitted to the hospital. The use of contraindicated medications was reduced by 41.5% (19.3% vs 11.3%). Over the 12 months after deployment, 547 PD patients were seen, and contraindicated medication use remained 25.6% lower than baseline. Length of stay was significantly longer for those who received a contraindicated medication at baseline and after the intervention. Involvement of pharmacists was associated with removal of inappropriate orders.