Evidence base: SIGN guideline 113 (Diagnosis and Pharmacological management of Parkinson's Disease) states that “patients should be warned about the potential for dopamine agonists (DA) to cause impulse control disorders (ICD)”. A retrospective case note audit into practice in this area was undertaken between August and December 2010 across four Scottish Health boards. The aim was to identify if there had been a documented discussion with patients and carers on the risk of ICD prior to commencing and continuing on DA.
Results: Documentation was suboptimal, with only 62% (104/167) of patients having recording at some point during their clinic attendance. Sub-analysis from Greater Glasgow and Clyde (GG&C) showed 81% (75/92) had documentation at some point during attendance. Only 10% patients had documentation of written information being provided, and 16% had documentation that carers were involved in discussion.
Change strategies: Following the initial audit, a patient agreement form for starting/continuing DA was designed and implemented in April 2011 across GG&C. This contained information on ICD, with signature space for patient, health professional and carer/relative. The audit was then repeated in July 2012 in GG&C, looking at the previous 12 months of practice.
Change effects: The repeat audit was based across 6 sites in GG&C. 94% (61/65) patients now had documented evidence of a discussion on ICD during their clinic attendance. 63% (41/65) had documentation of relatives being involved, 63% (41/65) receiving written information and a signed patient agreement was found in 35% (23/65).
Conclusion: In summary, the level of compliance with the SIGN guidelines has improved from 62% to 94%. Documentation of carer involvement is still suboptimal as is the percentage of patient agreement forms signed. The latter may be explained by the short time from development and implementation and follow up audit is planned.