NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Parkinson’s Disease in Acute Care

The Medicines Update Extra Bulletin on Parkinson’s Disease (PD) in Acute Care has been updated. This consists of a main bulletin and patient scenarios.

The updated bulletin contains the following key changes:

  • Recommendations on switching patients from rotigotine patch back to oral PD therapy once they are able to swallow safely 
  • Information added on peri-operative management of patients with PD 
  • Information added on management of complications in patients using co-careldopa intestinal gel (Duodopa®), including a new patient scenario 
  • Addition of a contents page for easier navigation within the main bulletin 

The main bulletin consists of 3 sections with detailed information on the general management of PD patients, the management of PD patients with swallowing difficulties or who are nil by mouth (NBM), and co-careldopa intestinal gel.

A summary of some key issues included in the Medicines Update Extra Bulletin are provided below. Please refer to the main bulletin for further detail.

Key learning/action points:

Identifying acute admissions to hospital

  • Clinical teams should always contact the PD specialist nurse to advise of all new PD admissions (especially if the patient is NBM).  Contact details can be found in Appendix 6 in the Adult Therapeutics Handbook
  • A PD dashboard has been introduced to help PD specialists identify PD patients admitted to acute hospitals in GGC, however, not all PD patients are captured from the PD dashboard

Ensuring the right medicine at the right time

  • PD medicines should be prescribed with exact times on the drug chart and ensure no doses are missed
  • A PD stock list is available to help source medicines and these medicines should be transferred with the patient when moving between wards/sites

Why is it important for PD patients to get their medicine on time?

It is vital that patients with PD admitted to hospital get their medication on time, every time.  Late (>2 hours) or missed doses can have serious consequences such as risk of Neuroleptic Malignant Syndrome, and can also lead to prolonged hospital stays.  PD symptoms can quickly get out of control and the patient may suddenly be unable to walk, move or get out of bed.  It is therefore important to annotate the exact times of PD medicines on the prescription chart.

How can I contact a PD nurse?

The PD specialist nurses in NHSGGC should always be informed of a patient’s acute admission to hospital by the clinical team looking after the patient. Contact details can be found in Appendix 6 in the Adult Therapeutics Handbook.

How can I obtain supplies of PD medicines?

Across GGC hospitals there are specified areas holding stock of a range of PD medicines, this list can be found in the Adult Therapeutics Handbook.  Supplies should be obtained by contacting the holding areas directly or via the on call pharmacist for the site to avoid missed doses.  Please ensure any PD medicines are transferred with the patient when transferring between wards/sites.

What is the Parkinson’s Disease Dashboard?

This is an electronic system designed to help identify patients with PD who have been admitted to acute hospitals across GGC.  Only PD specialists have access to this system and it is routinely used by PD nurses who proactively contact the ward and confirm the patient’s usual PD medicines.  If the patient is unable to swallow they will advise on how to manage this and direct ward staff to the nil by mouth guidance which can be found on StaffNet here.  The PD nurses/consultants may also visit the ward to review specific patients whose PD symptoms are not well controlled. The introduction of the PD dashboard does not negate the need for clinical teams to contact PD specialist nurses to advise of a PD patient’s acute admission to hospital.

 

Published 11/09/18