I’ve heard too many horror stories of patients with Parkinson’s (PD) in the hospital for non-Parkinson’s conditions.
Problem: Many of the problems that PD patients encounter in the hospital relate to medications such as wrong medications being dispensed or correct medications not being dispensed on a timely basis or not at all.
Possible Remedies: Provide a typed list of patient’s medications and make sure it is written into the doctor’s orders. List should include:
Name of medication including whether it is standard or long-acting form (CR)
Strength of medication
Specific times that medication should be administered (specify exact times such as 7 AM, 11 AM, 3 PM, 7 PM instead of four times a day)
Whether medication should be administered with or without food, before, during or after meals
Whether the medication can be crushed
In case the patient's medication is not stocked in the hospital, patient may want to bring own medication from home in its original prescription bottles and give to nursing staff to administer.
Problem: Some PD patients find their PD symptoms worsen while in the hospital. One possible cause is the introduction of new medications in the hospital and how they interact with PD medications.
Possible Remedies: Become an informed patient. Develop a list of medications that should not be administered with patient's current PD medications. For example, certain drugs block dopamine receptors and worsen PD symptoms.
Find out if patient's PD meds need to be temporarily stopped before surgery.
Problem: Some PD patients who have had deep brain stimulation (DBS) experience problems because their hospital and surgical staff are not familiar with this surgery.
As a general rule, patients who have had DBS should not have a MRI.
The patient who has had DBS should bring the portable Medtronic Access Device and turn off the neurostimulator before having any type of surgery or certain tests such as EKG and EEG. The patient must assume the primary responsibility of turning the neurostimulator off and on and not rely on the medical staff to do this.
If the surgeon uses electrocautery during surgery to stop the bleeding, it potentially could reset the neurostimulator to its factory settings. As a precaution, only bipolar electrocautery is recommended.
If there are any questions or concerns, contact Medtronic directly.
Problem: It is often difficult for the PD patient to act as his/her own advocate while hospitalized.
Possible Remedies: The best solution is to arrange for someone (or several people doing shifts) to be with the patient round the clock or at least 16 hours/day, as an advocate. I wouldn’t have considered this necessary until I heard some scary stories where it was important that the advocate intervened. The advocate’s role is to monitor the patient’s care, including the medication, and educate the staff about PD.
Problem: Sometimes a life-threatening emergency develops while a patient is in the hospital.
Prepare a living will (my favorite is Five Wishes) or a durable health care power of attorney. Bring this document to the hospital to be placed in patient's medical chart.
Choose an advocate to ask questions and act as spokesperson.
For further information on hospitalization of PD patients, check out the following articles: