Hospital challenges

hosp challContributed by William Hicks

Many hospitals are not prepared for the unique and regimented care require by the PD sufferer so the caregiver must be a forceful advocate to ensure the appropriate treatment for the patient. The following areas require particular planning and vigilance:

Medications: Most PD sufferers take many medications on a rigid schedule. Hospitals are lax as to the medication delivery schedule—plus or minus an hour is fine with their requirements but unacceptable for many PD patients. The caregiver must be positive and persistent to have the meds administered on the patient’s schedule, not the hospital schedule. My experience is that it can be done, although I may get the meds from the nursing station and administer them myself, and yes with enough nagging, the on-duty staff was willing to accept that approach. The second issue with meds is that the hospital pharmacy may not have all the meds the PD patient requires and may try to substitute. I offer to provide the meds they do not have and they accept the offer but the meds must be approved by the pharmacy which may be a hassle but doable and worth it. If the hospitalization is planned, the meds issues can be worked on in advance so they are less of a struggle when the patient is in the hospital. When the hospitalization is unexpected and possibly via the emergency room, be prepared to be persistent, bring the meds to the hospital and attempt to force maintenance of the patients meds schedule. You may need to have a prepared hospital kit and instructions in readiness for the possibility of an unexpected hospitalization.

Anesthesia: General anesthesia may result in significant after-effects in PD sufferers. Confusion, hallucinations, irrational and combative behavior can persist for a couple weeks making recovery more challenging and dealing with the patient more difficult. Surgeons and anesthesiologists seem unaware of this hazard. The meeting with the surgeon and anesthesiologist just before the patient goes into surgery is particularly important, will take more time than is allotted and may require forceful advocacy on behalf of the patient. Push for the use of a local anesthetic with minimal sedation. Discuss the unique impact of general anesthesia on PD patients. You can find multiple write-ups on the hazards of anesthesia on various PD websites. Google will provide lots of references. Go to the preop meeting prepared to be a strong advocate for the patient.

Caregiver in the hospital: If the PD sufferer has a full time caregiver at home, consider the necessity of providing someone in the room with them while hospitalized. This may be particularly important if general anesthesia has been used or if the patient is uneasy to be alone. It may not be necessary, but be aware of the potential need. The hospital may provide a “sitter”, but so long as a “sitter” is required, discharge may be a problem.


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