What question did this study set out to answer?

To develop and evaluate a guideline for clinicians managing Parkinson’s patients who are nil by mouth.

February 8, 2026

3742 A QIP to develop trust-wide guideline for Parkinson’s patients while nil by mouth to improve confidence in clinicians

Key Points

To develop and evaluate a guideline for clinicians managing Parkinson’s patients who are nil by mouth.
Collected prospective data from doctors via Google forms
Identified knowledge gaps and areas for improvement
Developed a Trust-wide guideline for managing PD patients
Conducted teaching sessions for resident and foundation doctors
Assessed changes in confidence levels post-intervention
88.9% of respondents manage PD patients regularly
55.6% lacked confidence with NBM patients prior to training
72.2% were unaware of local specialist review pathways
Post-training, 83.3% reported improved confidence in managing NBM patients

Abstract

Abstract Introduction Parkinson’s disease is a progressive neurological degeneration of certain cells (called dopaminergic cells) within a specific part of the brain (substantia nigra). (1) Withholding PD medication or a prolonged delay in administering PD medication can lead to an increase in care needs and increases the risk of neuroleptic malignant type syndromes, which can be fatal. (2). Method Prospective data was collected among doctors of different grades working in the Trust using Google forms. Results Baseline data was collected in January 2025. 88.9% responders managed PD patients in their daily practice; majority of them were foundation year doctors (83.3%). 55.6% of the responders did not feel confident in managing patients with PD who were nil by mouth. 72.2% of the responders are not aware of the local pathways to request a specialist review and the OOH support available. A Trust-wide Parkinson’s Guidelines was then developed in reference to Parkinson’s patients who were nil by mouth or had swallowing difficulties; addressing all the concerned areas suggested in the baseline data collection. We then arranged two teaching sessions, first for the resident doctors in Geriatric Medicine department and a second session for Foundation doctors as they were identified as the target group of resident doctors during initial data collection. The second round of data collection was completed following these sessions. Following the sessions, we noted that the confidence level among responders significantly improved. We measured this on a rating scale of 1–5, with 83.3% responders reporting significant improvement in their levels of confidence managing PD patients who are NBM. Conclusion Symptomatic treatment, focused on replacing dopamine, is crucial in optimising patient outcomes and quality of life. (2) Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty. (3).

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