P.019 Safe prescribing of antipsychotic drugs in the elderly - Parkinson Disease

Abstract

Background: The Canadian Guideline for Parkinson Disease (PD) indicates clozapine and quetiapine are considered the only safe antipsychotics for people with PD, to avoid potentially exacerbating motor symptoms. In response to safety events in our centre, we explore contraindicated antipsychotic prescriptions being administered to hospital inpatients with PD to determine common factors and develop approaches to prevent future occurrences. Methods: Following a privacy impact analysis, the Interior Health Quality Improvement & Patient Safety Office identified inpatients at Kelowna General Hospital, between December 2018 and June 2021, with a coded diagnosis of PD. Pharmacy medication order and dispensing data were cross-referenced to determine patients exposed to a contraindicated antipsychotic for further chart analysis. Results: Of the 140 admissions with a PD diagnosis, 17 had at least one contraindicated antipsychotic prescribed or dispensed (12.1%). Loxapine (7) and haloperidol (6) were the most frequently prescribed. This occurred despite a diagnosis of PD being noted on admission in 14 cases, and 13 cases were known to be taking levodopa. Conclusions: These results demonstrate additional safety measures are needed to reduce the frequency of contraindicated antipsychotic prescriptions in this population. We propose developing a stepwise plan for behaviour de-escalation and pharmacological management.