If yes consider the following Anticipatory Care Management of an acute deterioration in Parkinson’s symptoms- professionals Is the Person with Parkinson’s (PwP) experiencing e.g increased tremor, slowness of movement, rigidity, or a change in cognition, confusion, hallucinations, falls ? (deterioration in the last 2/3 weeks) If yes consider the following Is infection present? NB: PwP do not always display signs of infections therefore consider carrying out the tests /observations below: Urinalysis if positive send to microbiology. Blood tests for infection, delirium, falls inc: FBC, U&E’s CRP, TFT’s, B12 folate, LFT, calcium, random glucose. Examine chest-risk of aspiration refer to SALT for swallow assessment. Any wounds, infected rashes. Falls- with or without infection; check Lying & Standing BP after 1 & 3 minutes to rule out postural hypotension. Complete multifactorial falls assessment. Is the PwP constipated? Have their bowels opened within the last 2/3 days or consistent with the patient’s normal bowel habit. Has the PwP taken or been given any new medications within the last month? Check the medications to see if it is one to avoid / contraindicated in Parkinson’s (see list overleaf & BNF for further information). Assess the PwP for any medication side effects. Is the PwP taking their medication correctly as prescribed? Consider; correct patient, time, dose, route, medication. Yes Yes Yes No Positive infection screen If requiring treatment the PwP should generally return to their normal level of functioning. Constipation present Suggest an increase in dietary fibre and fluid intake. If unsuccessful treat accordingly. Macrogols (Laxido) can be effective in Parkinson’s but choice depends on the individual. Medication Compliance Consider a patient medication management system/aid e.g. dossette box, pill timer etc. For those PwP with complex, frequent & timely dosing regimes, speak to the Parkinson’s Specialist to see if it is possible to simplify the Parkinson’s medication regime (with patient consent).  If PwP has symptomatic postural hypotension Check the PwP is drinking adequate fluids & review other medications e.g anti-hypertensive’s. Consider compression hosiery if not contra-indicated to other conditions e.g vascular /arterial. Refer to Specialist Nurse to discuss the Parkinson’s medication regime to see if requires adjustment. Refer to the their Specialist Parkinson’s Consultant for discussion as to whether anti-hypotensive medication indicated and appropriate for the patient. Authors Kay Baggley, Kathryn Prout, Parkinson’s Nurse Specialists. Adapted from Barnes, L,PDNS, Peninsula Community Health 01/17Review date 01/19 Increase in PwP Social Care Needs /Carer Stress Consider referral to Care Direct- 0117 922 2700. Carers Centre-0117 965 2200. South Gloucester shire Social Services Tel No: 01454 868007. Options for support -Community Pharmacist, GP, Parkinson’s Consultant or Parkinson’s Nurse Specialist Kay Baggley PNS South, Inner city & East Bristol -0117 919 0289 Sally –Anne Wherry PNS North & West Bristol – 0117 414 1593 Kathryn Prout PNS , South Glos -0117 330 2521