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Abstract Details

Is It Possible to Eliminate Hospital Administered Haloperidol For the Acute Management of Agitation in Patients with Parkinsonism? A Quality Improvement Initiative
Movement Disorders
P12 - Poster Session 12 (12:00 PM-1:00 PM)
3-002
To eliminate the use of haloperidol in the acute management of agitation in parkinsonism patients 

Almost 90% of patients with parkinsonism are affected by neuropsychiatric symptoms. 20-40% of patients will exhibit agitation, delusions, hallucinations, or other aberrant behavior. Haloperidol, a typical antipsychotic, remains a common treatment for agitation in the hospital. Haloperidol can worsen the motor symptoms of parkinsonism through its potent dopamine receptor blocking activity and is associated with increased mortality in parkinsonism patients.
Data for patients with parkinsonism admitted to Boston Medical Center (BMC) were obtained from the electronic medical record.  Patients were divided into those who received haloperidol during hospitalization and those who did not. Groups were analyzed for significant differences in outcomes. We then provided educational lectures to the emergency, psychiatry, internal, and family medicine departments to raise awareness and encourage alternative pharmacologic therapy. Pre- and post-lecture assessments were administered to gauge lecture effectiveness.
393 patients with parkinsonism were admitted to BMC from 2014-2018. 13.7% of these patients received haloperidol during hospitalization, averaging one haloperidol administration every 3 weeks. Statistically significant changes in outcomes included longer lengths of stay, greater 30-day readmissions, and fewer discharges home for the haloperidol group. Prior to our lectures, nearly 50% of providers chose haloperidol as the best option for acute agitation in parkinsonism patients.  Less than 5% selected haloperidol following our lectures. Respondents also reported increased comfort in treatment of acute agitation in parkinsonism patients.

There are no peer-reviewed guidelines for treating agitation in parkinsonism patients. Oral clozapine and quetiapine are the most effective antipsychotics that do not significantly worsen motor symptoms. Unfortunately, these are not well-suited for acute situations. From our initiative, we successfully petitioned our inpatient pharmacy to add intramuscular olanzapine to the formulary, a safer antipsychotic option for parkinsonism patients.
Authors/Disclosures
Katelyn C. Bird, MD
PRESENTER 		Dr. Bird has nothing to disclose.
Taylor N. Francoeur No disclosure on file
Betsy Thomas, MD (NYU Langone) No disclosure on file
No disclosure on file
Stephanie L. Bissonnette, DO The institution of Dr. Bissonnette has received research support from SAGE Therapeutics. The institution of Dr. Bissonnette has received research support from Huntington's Disease Society of America. The institution of Dr. Bissonnette has received research support from CHDI Foundation.