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Mary Ann, I basically agree with your statements but I have several additions and modifications. Self administration is the best way of insuring this if the hospital allows it and if the PWP is alert and responsible. It is important to get meds on time for PD patients more than most others. Nurses who don't work with us often don't know ar appreciate this and therefore are often lax in the attention that they pay to this. The "standard" of care is about + or - one hour for meds to be considered on-time for their purposes. This of course can be a disaster for a PD patient. If you are admitted to a hospital unit it is important that you meet and discuss this with the nursing staff and head nurse that will be caring for you. The doctor should write the tolerance he has for the time medications should be given e.g. + or- 15 min. any variation from this order should be reported to the head nurse. Don't worry about getting a nurse in trouble. Likely it will take may incidents similar to this before a nurse is disciplined but it can serve as a makeup call. If you are a caregiver and the PWP is not able to self administer PD meds the above becomes even more crucial. Give the nursing staff a printed schedule for medications. When you are visiting check the medication doses against your copy before it is given to the PWP. I have had both relatively good and bad experiences with meds. When I was hospitalized about 2 years ago I was on a neurology and then a rehab unit. Since the staffs were both well-trained with PD patients and I was under the care of a Movement Disorders specialist or a physiatrist trained in PD that experience was relatively good with only minor variations in med times. On the other hand when I was admitted to the same hospital for my STN DBS surgery I had a surprise waiting for me when I went into the ICU from the OR. The neurosurgical resident had written for me to have Sinemet 25-100 4x per day. more than 1/2 my usual daily dosage. Also and more importantly the frequency had been cut back from every 1 1/2 hours to every 4 hours. When I realized the error I told the nurse. She tried to contact the doctor who was unavailable. And she was stuck with a patient who is also a physician in pain- telling her one thing and the doctors to whom she is responsible saying another. I presume the residents knew little about the medical treatment of PD. In any case we were able to compromise until she could eventually reach the MD's but that and one or two other med errors made me aware of this problem even more acutely. Be careful when you are hospitalized regarding meds. Even the best hospitals make errors- especially with PWP. Charlie > As a medical nurse who is still actively involved in my profession, I > thought it might help list members to understand the 'other side' of the > dilemmas Bob experienced with his wife's hospitalization and perhaps offer > some suggestions as to how they can be avoided. > > Bob Anibal wrote: > One year ago Aug 7 Cecily had a stroke while in the hospital for > >pneumonia. The neuro ( not our neuro) called in, immediately decided she > >needed more sinemet. She said that every neuro had different ideas about > >dosage of PD medicines. Being in a state of shock I didn't realize what > she > >was saying. After it sunk in I eventuall got our MD to change it back. I > >also told him that under no circumstances was that person to be allowed > >near any of my family - get a witch doctor first. > > In teaching hospitals (where interns and residents follow patients) such > situations commonly occur. To avoid this kind of encounter, request that > your physician stipulate that you be 'non-teaching' - thus preventing > interns and residents from over-seeing your care. The down-side to such a > stipulation is that in emergency situations, attention to your problem might > not be as immediate as possible. Your physician must be called for any > orders in regard to your case. If he's indisposed (at a wedding, funeral, > on the golf-course or out of town) getting timely medical care might present > some difficulty. > > If you decide that you wish to remain a 'teaching patient', then *clearly* > express that under no circumstances may your PD meds be changed without > direct consultation with your neurologist (this was Bob's solutionin his > wife's case). > > As a nurse I recommend the latter. > > >In Feb she was in the hospital again and altho I had given the nurse a > >writtten program of her medications, I caught them giving her a wrong > dosage > >at a wrong time. Asking around I found that they had a different regimen > >than the one I had given. When as and if she is ever in the hospital - any > >hospital - again you can bet your bottom dollar I will see that they do > >what they are supposed to - not what THEY think they should. > > Hospital medication schedules are often very different from the regimen > patients have established for themselves. Although we would love to > accomodate patients, it is often difficult to administer medications on > 'patient time' as opposed to 'hospital time.'. To give Annie meds at > 6-10-2-6 and Jim meds at 8-12-4-8 and Tom meds at 9-1-5-9 would dictate that > the only function a nurse could carry out would be to pass meds to patient > to the exclusion of other medical care. > > Therefore, if you have a medication schedule that must remain constant, > request that your physician write orders that specify that you may keep > your meds at the bedside so that you can take them whenever you need them. > If you are a care-giver whose charge is not of sound mind and thus cannot be > trusted to take their meds on their own ask that your doctor write specific > times when meds *must* be administered. > > Hospitals are very busy places. On my clinical division where cardiac and > respiratory problems are the major focus, emergencies occur every day. > Frequently medication schedules are thrown off because of those crises. We > try very hard to insure that our patients be managed in an optimally > therapeutic environment, but sometimes our best efforts fail. It is > important that all contingencies in regard to medication administration be > anticipated by staff and patients so that rapid recovery can occur and the > patient can be discharged back to their normal environment. We need your > help for that to be accomplished. > ------- > Regards > Mary Ann -- ****************************************************************************************** Charles T. Meyer, M.D. Middleton (Madison), Wisconsin [log in to unmask] ******************************************************************************************