Abstract
Advanced Parkinson's disease patients frequently suffer from various complications, such as on-off phenomenon and wearing-off (diurnal fluctuation), and drug induced psychosis (DIP). So they must often be hospitalized for the care of these phenomena. During these periods, the use of a critical pathway may be helpful for these patients. We made a critical pathway for the advanced Parkinson's disease patient who needed educational hospitalization for their long-term care system, and internal drug adjustment and control hospitalization. Then, we used the critical pathway for five patients of Parkinson's disease (Hoehn & Yahr stage III-IV) who were hospitalized for internal medicine adjustment for diurnal fluctuation, and/or for DIP, and we examined the indications. As the results, team approach for medical care among medical staffs (a dietician, a pharmacist, a physical therapist) was improved. It became easier to share between staff information about the effects of drug control. We achieved standardization of patient evaluation by using Unified Parkinson's Disease Rating Scale (UPDRS) and the evaluations were useful in the therapy effect evaluation. On the other hand, there was a significant variation in the five cases and so tailor-made therapy was needed for the Parkinson's disease patients. The application of a critical pathway will bring a profound quality improvement to medical staffs and hospital management, and of course to Parkinson's disease patients.
