Parkinson’s disease (PD) is a complex neurodegenerative disorder [1]. The motor symptoms of PD include tremor, rigidity, and postural instability, and the non-motor symptoms include autonomic dysfunction, mood disturbances, cognitive impairment, sleep disorders, and pain [2]. When compared with patients of the same age and gender, patients with PD admitted to acute care hospitals in Australia are five times more likely to be treated for delirium, three times more likely to experience adverse drug events and syncope, and more than twice as likely to require management for falls with injury, dementia, gastrointestinal complications, urinary tract infections, and reduced mobility [3]. Hospital admissions are associated with worse outcomes, often resulting in the worsening of motor symptoms, medication errors, hospital-acquired complications, longer lengths of stay, and higher readmission rates [4]. The early identification of this vulnerable cohort of patients enables clinicians to recognise those at risk of complications early and work with multidisciplinary teams to reduce the impact of these complications on the patient and their hospital stay [3].

People with PD often have highly individualised, complex medication regimens. Frequently, these regimens are incorrectly prescribed and administered in hospital [5]. A partnership approach between patients with PD and the healthcare team is required for the delivery of medications to the patients at the correct, individualised times. Medical officers are required to prescribe medication appropriately and accurately, and nursing staff are required to administer the prescribed medications in accordance with the given orders [6,7]. However, the timely administration of PD medications, particularly those containing levodopa, in hospital is poor [6]. The timely administration of levodopa has been shown to be difficult due to the limited awareness of staff regarding the importance of the timely administration for PD symptom control and the limited availability of the medication [8]. Globally and in Australia, only half of PD medication doses are given in a timely manner in hospital [1,9]. The importance of improving the prescribing accuracy and timely administration of PD medications in hospital is clear when considering the consequences of medication mismanagement. Non-adherence to PD patients’ individual medication regimens in hospital contributes to the fact that patients with PD are 1.5 times more likely than patients without PD to have a longer length of stay [6]. Untimely administration can worsen symptoms, which can cause hospital-acquired complications, such as delirium, falls, and constipation, placing a burden on the healthcare system [6]. Although the prescribing accuracy of PD medication management and the administration in hospital is multifactorial, pharmacists play an integral role in this process. Proactive interventions utilising pharmacy technology, workflow, and staffing have previously been shown to improve accuracy and safe hospitalisation for people with PD [10]. Unless the identification of PD patients occurs earlier and their medications are managed efficiently and effectively, PD patients’ symptoms will continue to worsen in hospital. This will consequently worsen their hospital experience and health outcomes and increase their length of stay [3,4,6]. Harris et al. [11] demonstrated that the clear and early identification of PD patients within the emergency department (ED) reduced their length of stay in the ED. The effective identification of PD patients improved the timeliness of PD medication administration, the prescribing accuracy of PD medications, and the timeliness of a medication reconciliation review by a pharmacist. Medication reconciliation—the identification of current medications and the regime in which they are taken— is an important factor in the safe care of patients with PD. Previous studies have suggested that medication reconciliation has a positive impact on reducing the length of stay and mortality rate by reducing medication errors by 51% [12].

Healthcare redesign is an approach to health service improvement that involves understanding and investigating the root causes of an identified health systems and processes problem. Developing evidence-based, co-designed solutions for meaningful and sustainable outcomes is integral to healthcare redesign, which makes this approach suitable for medication management issues in acute care. Previous studies using this approach have demonstrated positive outcomes for PD patients [13]. Healthcare redesign comprises five main phases for successful health service improvement. Firstly, the scoping phase involves the identification of a healthcare service delivery problem and the development of a project aim to improve the current situation. The aim should consider three viewpoints: patients, healthcare workers, and the healthcare organisation [14]. Furthermore, defining the scope of the problem and understanding the sphere of influence is critical in the scoping phase of redesign. The second phase of redesign, diagnostics, involves understanding the current, baseline situation and how it contributes to the identified problem. The following three phases, solution design, implementation, and evaluation, focus on developing evidence-based, co-designed solutions, and the implementation and evaluation of those solutions.

It is estimated that 0.8% of the urban population around the RNSH live with PD [7], which equates to approximately 7885 people living with PD in the local health district. Previous work with RNSH organisational data (2021) demonstrated that only half of PD medication doses were administered on time, which is consistent with the literature [1,6,11]. Furthermore, 45% of pharmacist reviews at RNSH identified a PD prescribing error, and there was no systematic means of identifying PD patients. The identification of PD patients in an acute care hospital has been shown to improve outcomes, such as the accurate prescribing of medication, improved timeliness of medication administration, and increased pharmacist medication reconciliation [13,18,19,20]. While a system for the identification of PD patients currently exists within the ED at RNSH, this project identified that many staff were not aware of it, and it is not routinely used. Additionally, this system of identification is not integrated beyond the ED, meaning that there is currently no specific method of identifying PD patients on the Neurology ward or the Aged Care ward. Without clear identification of PD patients in the ED and on the wards, pharmacists, doctors, and nurses are unable to effectively prioritise reviewing PD medications, prescribing PD medications, and administering PD medications. Mistakes are easily made when prescribing PD medication regimens, making pharmacist reviews important, as prescribing errors are more likely to be identified. If such errors are not detected efficiently, they are often perpetuated throughout the admission. This can result in poor PD symptom control and poor outcomes for patients.

PD patients will frequently come into contact with medical staff who have limited expertise in PD, which creates significant challenges throughout their hospital admission [1]. Medical officers at RNSH were not confident that medications were prescribed accurately. Medication timing errors were the most common error found. PD medications were often not administered on time, partly because the nursing staff were not aware that ‘on time’ means within 15 min of the prescribed time, according to the NSW Health safety notice [7]. Access to PD medications and an eMR system that does not advocate for timely administration and workload also contributed to untimely medication administration, which is consistent with a previous study looking at pharmacy strategies for improving medication administration [10]. The staff indicated that their knowledge of PD medications was poor, and there was limited routine education provided to specifically address the knowledge gap for accurate prescription, efficient review, and timely administration. Multiple studies have shown that this knowledge gap is common, and improvements to medication management can be achieved with the implementation of education programs within acute care hospitals [6,8,21,22,23,24]. Interestingly, despite the hospital’s poor performance, the patients and carers perceived that their doses were administered on time.