Recommendations for Medication-Use Safety for Hospitalized Patients with Parkinson’s Disease

Background

Hospitalized patients with Parkinson’s disease (PD) are at high risk for preventable medication-related harm [1–5]. Unlike many chronic diseases, successful management of PD depends on individualized medication regimens that require administration at precise times [1–3,6,7]. Omitted doses, abrupt discontinuation, exposure to contraindicated medications, or even brief delays in medication administration can result in rapid clinical deterioration, including worsening motor function, impaired swallowing, delirium, prolonged hospitalization, and, in severe cases, life-threatening complications [1–3,6–10]. Despite these well-recognized risks, hospitals frequently lack standardized systems to ensure safe medication management for patients with PD [1–5,7].

Medication Safety Concerns

Medication safety teams should recognize PD as a high-risk condition requiring organization-wide safeguards [1,3–5]. The greatest opportunities to reduce preventable harm involve addressing the following system failures:

  • Failure to identify patients with PD early and activate standardized care processes at admission. Particularly challenging when a patient is admitted through the Emergency Department or for a diagnosis other than PD [3–5,11].

  • Incomplete medication reconciliation, including failure to determine a patient’s exact home medication schedule that reflects dosages, formulations, dietary considerations (e.g., protein intake), and the time of the last administered dose of each medication [1–3,5–7,9,12].

  • Failure to administer Parkinson’s medications in accordance with the patient’s established home schedule, resulting in delayed, omitted, or abruptly discontinued therapy. Particularly challenging when the patient is transported off the patient care unit for diagnostic tests, procedures, or other services [1–3,5–7,10].

  • Inadequate planning for nothing by mouth (NPO) status, swallowing impairment, procedures, surgery, or medication unavailability, leading to missed or delayed doses of Parkinson’s medications [2,3,5–7,10,12,13].

  • Prescribing medications that can worsen PD symptoms if drug-disease interactions are not recognized or prevented. Particularly concerning for dopamine-blocking antiemetics and antipsychotics, which may be included in standard hospital order sets but are inappropriate for patients with PD [1–3,5,7,8,13,14]. 

  • Insufficient coordination among care providers (e.g., hospitalists, neurologists, movement disorder specialists, pharmacists, nurses, rehabilitation services), patients, and care partners throughout hospitalization and during transitions of care. Particularly important if the patient’s usual PD provider is not affiliated with the hospital system [1–5,7,9,10,12].

Call to Action 

NCC MERP recommends that hospitals develop standardized, multidisciplinary processes with organization-wide safeguards intended to identify patients with PD at admission, ensure accurate medication reconciliation, support exact-time medication administration, prevent harmful drug-disease interactions, anticipate swallowing and perioperative challenges, and actively engage patients and care partners in medication management [1–5,7,9–14]. These system-based interventions can substantially reduce preventable medication errors and improve outcomes for hospitalized patients with PD [1,5–7,13–15]. 

 

References

  1. Carpentier AV, Malaty IA, LeWitt PA, et al. A systematic review of the Parkinson’s Foundation hospital care recommendations. Mov Disord Clin Pract. 2026;13(1):29-43. doi:10.1002/mdc3.70247

  2. Cohen MR, Smetzer JL. Delayed administration and contraindicated drugs place hospitalized Parkinson’s disease patients at risk; doxorubicin liposomal mix-up; avoid mix-ups between hydroxyprogesterone and medroxyprogesterone. Hosp Pharm. 2015;50(7):559-563. doi:10.1310/hpj5007-559

  3. Parkinson’s Foundation. Parkinson’s Foundation Hospital Care Recommendations. April 2023. Accessed October 21, 2026. https://www.parkinson.org/sites/default/files/documents/hospital-care-r…
  4. Parkinson’s Foundation. Making Hospitals Safer for People with Parkinson’s Disease. April 2022. Accessed October 21, 2026. https://www.parkinson.org/sites/default/files/documents/hospital-care-r…
  5. Pronovost P, Pelton LJ, Azmi H, et al. Advancing Parkinson’s care and patient safety through CMS’s Age-Friendly Hospital Measure. Jt Comm J Qual Patient Saf. 2025;51(12):772-777. doi:10.1016/j.jcjq.2025.09.005
  6. Fisher J, Scott C. Reducing delays in time-critical medications for Parkinson’s disease: a multifaceted, multiprofessional quality improvement project. BMJ Open Qual. 2026;15(1):e003715. doi:10.1136/bmjoq-2025-003715
  7. Yu JRT, Sokola BS, Walter BL. Optimization of inpatient medication administration among persons with Parkinson’s disease: recommendations on pharmacy technology and workflow. Front Pharmacol. 2023;14:1254757. doi:10.3389/fphar.2023.1254757
  8. Coleman C, Smiley A, Rosenfeld S, Brooks A. Improving recognition and management of inpatient delirium in Parkinson’s disease: evidence review and implications for clinical care. Front Aging Neurosci. 2025;17:1693827. doi:10.3389/fnagi.2025.1693827
  9. Parkinson’s Foundation. Parkinson’s Care Summary for Health Professionals. March 2025. Accessed October 21, 2026. https://www.parkinson.org/sites/default/files/documents/care-summary-he…
  10. Safarpour D, Brooks A, Smiley A, et al. Consensus expert recommendations for management of dysphagia during hospital admission in Parkinson’s disease. J Parkinsons Dis. 2026;16(1):16-35. doi:10.1177/1877718X251410503
  11. Parkinson’s Foundation. Parkinson’s Disease in the Emergency Department Toolkit. March 2026. Accessed October 21, 2026. https://www.parkinson.org/sites/default/files/documents/PD-Emergency-De…
  12. Parkinson’s Foundation. Hospital Safety Guide. April 2026. Accessed October 21, 2026. https://www.parkinson.org/resources-support/hospital-safety-guide
  13. Salgado-Cámara P, De la Casa-Fages B, Sánchez-Soblechero A, Mateo Sierra O, Martín-Barbero ML, Grandas F. Impact of a perioperative protocol for Parkinson’s disease patients on use of contraindicated drugs. Neurologia (Engl Ed). 2026;41(1):101897. doi:10.1016/j.nrl.2023.11.011
  14. Xu Z, Jiang A, Bujala N, et al. Impact of best practice advisory on reducing contraindicated medications in hospitalized patients with Parkinson’s disease. Parkinsonism Relat Disord. 2026;142:108129. doi:10.1016/j.parkreldis.2025.108129
  15. Parkinson’s Foundation. Parkinson’s Foundation Hospital Care Learning Collaborative. Accessed October 21, 2026. https://www.parkinson.org/resources-support/professionals/our-care-stra…


 

 

For Patients

When a patient with Parkinson’s Disease is hospitalized, provide Healthcare Workers with:

  1. A detailed list of your medications, doses, and time of administration.

               For a printable medication form that includes special considerations, complete the “Medication Form” found at: https://www.parkinson.org/sites/default/files/documents/medication-form-fillable-2025.pdf   

  1. A copy of the following information that will help prevent medication errors in the hospital:

     

I have Parkinson’s disease.

NCCMERP developed recommendations to help avoid medication errors in hospitalized patients with Parkinson’s disease. 

Please review recommendations at [INSERT WEBSITE LINK] and discuss them with me, my care partner, and my healthcare team.

Adopted