Medico-legal concepts in Neurology – The Parkinson’s Patient
Neurology in general is a complex set of disease processes, which not every Nurse will be familiar with. However, the basics of good quality care still apply and every patient with a Neurological condition can still present with something that is not related to the Neurology. This said, Nurses must keep that disease in mind when planning care. Nurses and Care Staff must be very mindful that every patient is different and there is no one size fits all treatment plan. It is not unusual to hear Nurses comment that they don’t feel comfortable with these patients. Why? Well I believe that it’s a fear of the unknown and lack of knowledge rather than deliberate negligence. Unfortunately, poor care does happen.
Some potential areas of problems arising:
- Missed diagnosis
- Not looking beyond the current diagnosis when patient presents with symptoms
- Failing to treat appropriately, no access to other treatment options
- Failing to provide appropriate care in Nursing and Care homes
- Medication not reviewed, amended
- Medication not prescribed correctly, stopped or altered inappropriately
- Symptoms miss management
- Missed spinal problems in MS patients
- Poor symptom control in PD
- Falls not assessed and reviewed
- Patients not reviewed according to NICE guidelines
- Making assumptions about a patient’s ability before they assess them
Let’s take a patient with Parkinson’s disease for example. The patient has been extremely well managed at home by their Neuro/PD Nurse, GP etc., they are admitted to hospital with a fractured hip due to a fall (falls are very common in PD). Now, this is where it all can go badly wrong. Firstly, they are out of their normal routine (vital in PD), they may be in pain and immobile. What do Nurses do first? They will often then take away the patient’s medication and tell them that they will administer the tablets on the drug round. Most PD patients have a complex regime of different medications, which have been finely tuned to suit their needs. Removing this regime causes huge problems. The patient’s mobility is already reduced by the fracture, but now they have the added lack of medication, which means, stiffness, lots of “off periods”, freezing on the spot and a feeling of not being in control. The ability to communicate, eat, drink and care for themselves can easily be lost. This leads to frustration, upset and often confusion and depression. Nursing staff must make a detailed and accurate assessment of the medication including timing and make sure that not only is the care plan reflecting this but the patient gets their medication when they need it. Poor care for the PD patient can mean the difference between a settled co-operative and well managed patient and a distressed one, requiring much more hands on care. Removing a patient’s medication regime is in effect taking away their independence. The result of inadequate medication provision in a hospital, Nursing or care home setting is very common. It leads to distress, not only with the patient, but their family too. Often these patients are fully mobile and coping extremely well prior to admission, but are discharged immobile, on a different medication regime and have to start again with trying to stabilise their condition. PDUK have been running a long standing campaign “Getting It On Time” to try and highlight this problem. Things have improved in some areas, but there is still a long way to go before every patient does get their medication on time.
Parkinson’s disease is in the top 5 Neurological conditions along with Multiple Sclerosis and Epilepsy. All these conditions require accurate delivery of medication to maintain the patients wellbeing. More and more, as hospitals, care homes and nursing homes are getting busier and busier it is inevitable that these patients will be admitted with something other than their existing disease, therefore the provision of a high standard of attention to the medication is vital to ensure that these patients remain well and stable. After all, they are in your care and you must be mindful of them as a whole person not just the reason they are admitted.