My Patient With Parkinson’s Disease Can’t Swallow: Gulp…

James Fisher is an St6 in Geriatric Medicine at Health Education North East, and tweets at @drjimbofish

If you look after people with Parkinson’s Disease (PD) you’ll know that sometimes medication administration in hospital is sub-optimal. Things can get particularly challenging when patients are unable to take their usual tablets due to swallowing difficulties…

Missing PD medications is risky – not only will patients’ symptoms get worse, but abrupt withdrawal is associated with the rare, but potentially fatal, neuroleptic malignant syndrome.

PD specialist nurses provide an invaluable source of help and guidance for such situations, but swallowing problems overnight, or at weekends, may mean medical and nursing staff do not have a source of guidance for how to manage the medications.

The Northumbria Healthcare NHS Foundation Trust PD service developed an online medication conversion tool to help with this scenario – this can be freely accessed online.

Firstly, the tool asks you to enter the patient’s usual medications. The tool then calculates the equivalent doses of dispersible madopar for administration via a naso-gastric or ‘PEG’ tube. The tool also provides a suggested rotigotine patch dose, for situations where transdermal delivery of replacement medication may be more appropriate e.g. end of life care.

We hope you find this tool useful in your practice – if you do, please consider sharing it with your colleagues. We’d also welcome any feedback you might have about the tool – please follow this link for a very brief online survey:

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