29 Diagnosing and managing non-cognitive symptoms in parkinson’s disease: an audit of assessing clinician’s adherence to nice guidance (cg35)

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ObjectiveThis Audit is a University of Southampton BMedSci medical student project in Liaison Psychiatry, in collaboration with the Parkinson’s team at University Hospitals Southampton.AimThe aim of the project is to firstly systematically review the latest evidence for assessment and management of non-cognitive symptoms in Parkinson’s disease (PD). The second aim is to audit clinician’s adherence to assessment, diagnosis and management of non-cognitive symptoms using an established database of consecutive patients seen in the Wessex Neurological Centre, University Hospitals Southampton. This will enable us to establish our current practice and to implement any necessary action plans as required.Thirdly, we compared clinician’s self-rated confidence in assessing motor symptoms against clinician adherence.Method1. We systematically review the evidence based interventions for assessment and management of non-cognitive symptoms in Parkinson’s.2. We used an established database of 200 consecutive patients with Parkinson’s’ disease under the care of University Hospitals Southampton Parkinson’s’ team in the last 2 years to identify patients for this audit.3. We audited adherence to NICE Guidance CG35 through reviewing individual patient records, identified using the database.4. The audit tool was piloted on 10 case notes and then the finalised tool and audit method was established.5.We audited the last 2 patient reviews by the Parkinson’s team from the individual patient notes using an audit tool assessing 22 non-cognitive symptoms in Parkinson’s.6. We also asked clinicians to complete a brief questionnaire to rate, their confidence in assessing non-motor symptoms in PD in line with NICE guidance CG35, how difficult it is in practice and what are the barriers to assessing them.7. Ethics Committee Approval was sought and given by the University of Southampton.ResultsThe results of the projects are not fully available. The results will be available by December 2016 and available for the full poster. Initial audit data suggests that experienced clinicians do not specifically use a tool or aide-memoire in practice to assess, diagnose and manage non-cognitive symptoms. Most patients do not have a documented comprehensive list of non-cognitive symptoms reviewed at every patient encounter. Systematic review of the evidence suggests non-motor symptoms are a major factor in determining overall disease burden in an individual. One survey reported that in particular the non-cognitive symptoms of balance problems, sleep disturbance, memory problems and dribbling were the most disabling symptoms. Sub-optimal treatment and management can lead to poorer quality of life.ConclusionWe aim to implement a collaborative audit action plan following the full results to enable more clinicians to easily assess, document, discuss and treat non-cognitive symptoms in Parkinson’s with patients.

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