[MikeyJ]

Originally Posted by cardiacRN2006

Why do people put questions up and then get angry when they get responses?


If you are giving the pt a dose that isnt' specified on the MAR, then YES, you are practicing medicine without a license.

I do not think it is "practicing medicine w/o license". If you don't give the med at all (if the pt. refuses it), then you are technically giving a dose not specified on the MAR. I don't see the difference.

Nurses I have worked with on the floor have given different doses if the patient refuses the full dose. The nurse of course will always follow up with the doctor and give them the situation and get a dosage change.

But I would think when working with a minor it would be different.

[cardiacRN2006]

It's also a med error, since the correct dose was not given.

[HonestRN]

Originally Posted by cardiacRN2006

Why do people put questions up and then get angry when they get responses?

I didn't detect any anger in the OP's response. Frustration maybe but not hostility.

Patients do have the RIGHT to REFUSE all or part of their medication. Patient Bill of Rights anybody?! The nurse should talk to the patient and attempt to ascertain why the patient is refusing part of the dose (perhaps the side effects?), call the doctor and explain the situation and then let the doctor either change the dose or do as the doctor did in the case of the OP. As always document, document, document.

Whoever commented that giving a half dose constitutes prescription fraud is just wrong. Google prescription fraud. Moreover if you document you are not defrauding anybody.

[cardiacRN2006]

Originally Posted by HonestRN

Whoever commented that giving a half dose constitutes prescription fraud is just wrong. Google prescription fraud. Moreover if you document you are not defrauding anybody.

The OP said that.

Look, the MAR says give X amount of drug. The pt can accept or refuse, but you can only GIVE what the MAR orders.

You cannot give more, you cannot give less. If the pt want's less, you get up and call the Dr and get the order changed. You do NOT make that decision for the pt. No matter what you think, that's called practicing medicine without a license.


At my hospital I'd get fired.

So if my pt has 40mg of lasix ordered for CHF, but they tell me they usually take 20 at home does that mean it's ok for me to give 20mg now? No. Either I give the whole dose, or give no dose. What if the pt wanted more? Is it ok for me to give more? What if they normally take 80mg at home?

I go by the MAR and bring it up with the Dr. But I don't decide on my own.

BTW, when pts refuse doses we still need to notify the Dr about it.

[Suesquatch]

I guess I'd be more worried about my CHF patient getting no Lasix or my young patient with seizures getting no trileptal than about nuances of interpretation.

I've often had a patient refuse some of his pills and the powers that be always supported that some were better than none. And we are always honest about it and document the heck out of it and have never been cited during survey.

[HonestRN]

Originally Posted by cardiacRN2006

You cannot give more, you cannot give less. If the pt want's less, you get up and call the Dr and get the order changed. You do NOT make that decision for the pt. No matter what you think, that's called practicing medicine without a license.

Ok you can get off your soapbox now. I stated as much when I said talk to the patient, ascertain why part of the dose is being refused and call the Dr. Now if the patient refuses part of a dose that is not the nurse making the decision it is the PATIENT exercising his/her rights. As we all know incorrect doses are at times ordered and by speaking with the patient and listening to their concerns you could potentially be helping to avoid a medication error.

Additionally, it was not the OP who called it prescription fraud, it was the pharmacy at her facility.

[aussiemags]

Originally Posted by nadjjaa

I have told her that it is her right to refuse her medications, and if she believes she only takes one pill at night, to refuse the other pill.

Meanwhile I have been trying to get ahold of the kid's doctor to clarify the order.

I dont have a problem with what you are doing so long as you document clearly on the medicaton chart and in the patient notes what you have done. Contacting the doctor is a must and should also be noted on the records.

[cardiacRN2006]

Originally Posted by HonestRN

Ok you can get off your soapbox now. .

How mature.

[caringnursenj]

"You cannot give more, you cannot give less. If the pt want's less, you get up and call the Dr and get the order changed. You do NOT make that decision for the pt. No matter what you think, that's called practicing medicine without a license"

Here's a hypothetical question. I got curious with what was stated stated here. What if the patient is on a certain pill, let’s say a Blood Pressure lowering medication called ABC. And he gets two ten mg pills of ABC (total dose is of course 20mg) as ordered. And so he takes one pill already, swallows it down, but refuses the other 10mg stating: “I refuse to take the other half, because at home I only take 10mg.” But you know very well through the records that 10mg doesn’t really bring his BP down, in fact that was the reason why the Dr. increased the dosage. What do you do then? Do you call the doctor and ask that the order be changed to just 10mg because he swallowed only 10mg? Any opinions? What would you do if you happen to be in this situation? Just asking.

[Suesquatch]

Originally Posted by caringnursenj

What if the patient is on a certain pill, let’s say a Blood Pressure lowering medication called ABC. And he gets two ten mg pills of ABC (total dose is of course 20mg) as ordered. And so he takes one pill already, swallows it down, but refuses the other 10mg stating: “I refuse to take the other half, because at home I only take 10mg.” But you know very well through the records that 10mg doesn’t really bring his BP down, in fact that was the reason why the Dr. increased the dosage. What do you do then? Do you call the doctor and ask that the order be changed to just 10mg because he swallowed only 10mg? Any opinions? What would you do if you happen to be in this situation? Just asking.

That's an easy one. Document what was given and note in the MAR and the nursing notes the refusal and reason. Contact the doctor STAT if the pt is unstable and otherwise in the a.m. (if evening or NOC) if in a SNF.

It happens in LTC all the time and is neither shocking nor unexpected. I would imagine cardiacRN's setting is high acuity and a refusal is critical and dangerous, necessitating a different and immediate response.