Department: CLINICAL QUERIES
Sarah Kovosi was a graduate of the University of Windsor with a special interest in PD who died in a tragic accident. Her professor, Michelle Freeman, is a lecturer in the Faculty of Nursing at the University of Windsor in Canada, a consultant in quality and patient safety, and a doctoral candidate.
My medical-surgical patient with Parkinson disease (PD) is worried about receiving his levodopa/carbidopa on time. Can you explain why?—J.R., MO.
Sarah Kovosi, BScN, RN, and Michelle Freeman, MScN, BScN, RN, replied: PD is a disorder of the central nervous system resulting from a lack of dopamine, an important neurotransmitter.1 Each patient is unique, but most experience bradykinesia, rigidity, postural instability, and tremor. Several other symptoms may occur in PD; symptoms gradually worsen as the disease progresses.
Levodopa, a precursor of dopamine, is the drug most commonly prescribed for PD. Dopamine doesn't easily cross the blood-brain barrier and is usually combined with carbidopa. This combination inhibits the breakdown of levodopa, making more drug available when it reaches the brain.2,3 For optimal symptom control, levodopa/carbidopa should be taken on a very precise schedule. Some patients fear hospital admission because they don't trust the staff to administer their medication on time.4
Many people with PD experience the "on-off" effect during drug therapy. During the "on" phase, the medication is working to decrease symptoms. In the "off" phase, the medication is wearing off and symptoms become poorly controlled. Although this can indicate the patient's response to the drug is changing or the disease is progressing, it can also result from medications not being given on time.2
Medications must be administered on time to promote consistent therapeutic blood levels and prevent disabling symptoms. A delay of even 5 minutes can cause the patient to suddenly lose the ability to move, walk, and speak.5
Most hospitals organize medication administration around standardized times and allow medications to be given 30 minutes before or after these times. But PD medications should be given on the patient's schedule, not the hospital's.
Follow these guidelines to ensure patients with PD receive their medications on time.
* On admission, during medication reconciliation, ask the patient about the specific timing of PD medications.
* Make sure medication prescriptions are written for these specific times instead of a general time.
* Flag the patient's medication administration record. Administer medications to these patients first.
* Use timers or alarm clocks to remind staff of medication that's due at nonstandard times.
* With the help of the pharmacy and therapeutics committee, introduce a self-administration policy for patients who can do so safely.4
1. Roberts BR. Caring for patients with Parkinson disease: your role. Nursing. 2010;40(7):58–64.
4. Sadler C. It's all in the timing. Nurs Stand. 2007;21(24):20–21.
5. Buetow S, Henshaw J, Bryant L, O'Sullivan D. Medication timing errors for Parkinson's disease: perspectives held by caregivers and people with Parkinson's in New Zealand. Parkinsons Dis. 2010;2010:432983. Epub 2009 Nov 5.
© 2011 Lippincott Williams & Wilkins, Inc.