can confused pts refuse meds?

  1. I had a really confused pt today with high blood sugars. He wasn't violent, but was incredibly aggressive, and I was worried he would become combative. To what point do you force these pts to take meds (iv, subq)? I had a resident insist that there's no way a confused or can refuse meds. It's my job to give it no matter what. Do i get several nurses to force him down, potentially making his behavior worse? And if I already feel that this pt might become violent with me, do I have to wait for him to actually hit me? I'm more annoyed that she said, well he hasn't become violent yet. I think you all get the issue I'm trying to figure out. At what point is it "okay" to place yourself in harm's way to ensure a confused pt takes their meds?

    Also, I just want to note, they really didn't want to add anything iv/im to help calm him. I asked.
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    About cwilliams032

    Joined: Feb '18; Posts: 6; Likes: 15
    Specialty: 1 year(s) of experience

    29 Comments

  3. by   sallyrnrrt
    I "court their mental state"
    Ie: I've got something to make you feel better, please help me etc?...
    Last edit by sallyrnrrt on Mar 18 : Reason: Sp
  4. by   Paws2people
    The resident isn't the one in the room who could potentially get hurt, now is she?

    It's easy to dictate how things should be done from afar.
  5. by   CelticGoddess
    Quote from cwilliams032
    I had a really confused pt today with high blood sugars. He wasn't violent, but was incredibly aggressive, and I was worried he would become combative. To what point do you force these pts to take meds (iv, subq)? I had a resident insist that there's no way a confused or can refuse meds. It's my job to give it no matter what. Do i get several nurses to force him down, potentially making his behavior worse? And if I already feel that this pt might become violent with me, do I have to wait for him to actually hit me? I'm more annoyed that she said, well he hasn't become violent yet. I think you all get the issue I'm trying to figure out. At what point is it "okay" to place yourself in harm's way to ensure a confused pt takes their meds?

    Also, I just want to note, they really didn't want to add anything iv/im to help calm him. I asked.
    When I was still in acute care the only time we held a patient down was when it was a psych patient whose MD's (always 2) write an order "Pt may not refuse meds". And we only used that when they got violent and would call security to told them down while we gave them Zyprexa or Geodon.

    When I had confused patients refuse meds, I would walk out of the room and give them a few minutes, then try again. I would also ask them if they wanted me to help them feel better and often times, if I gave them a bit of time, they would agree to the meds. I never forced them, per se. I will admit to manipulating them into taking them. But they, in the end, would agree.
  6. by   YUKONrn
    Yes they can, despite being confused, you can not "force" anything on anybody. It is outlined in the patient bill of rights.
  7. by   brownbook
    Bottom line is, (except for psych patients on 5150), a patient can refuse any med or treatment. You always notify the doctor. Of course for a potential DKA you would, but even for minor things, always notify the doctor.

    You can try theraputic interventions, open ended questions, active listening, etc., even some tricks or manipulations.
  8. by   Been there,done that
    This is not about you, it's about the patient. We can't force a patient to take meds, ( unless court ordered), holding a patient down is assault. I try once, then chart it and notify the physician.
    The resident is a jerk.
  9. by   CharleeFoxtrot
    Sure you can force a confused patient to take his/her medications. It's also called "assault" or "how to loose your license in 3 Easy Steps!"
  10. by   verene
    You cannot force medication on a patient (unless they are court ordered with second opinion approval for forced IMs in in-patient psychiatric setting).

    That being said you can always try different tactics to allow the individual to calm down and make the medication seem appealing, bring a coworker with you for safety while you try, and if an attempt or few doesn't work you contact the provider.
  11. by   SpankedInPittsburgh
    Yeah if a patient is competent they can refuse meds. If they are not competent there is a way to take their decision making abilities away from them through the 302 process. If nobody is doing anything to commit this patient and legally take his decision making capability away they get to make their won decisions including bad decisions. I get this all the time in the ER when a doc says I cant let a patient leave or have to force meds on them. I tell them if they are that convinced that this patient is a danger to themselves or others initiate a 302. They never do & the patient continues to call the shots which is (in my opinion) as it should be
  12. by   MunoRN
    A confused patient can refuse meds, an appropriately declared incompetent patient can't, confused and incompetent are not interchangeable terms since a person can be confused and still be competent to make their own medical decisions.

    There are typically separate requirements for declaring someone incompetent depending on whether the declaration is due to a psychiatric vs medical condition, and whether it is temporary or long term. In my state for an underlying reversible medical cause (delirium, encephalopathy, etc) two physicians must declare the patient incompetent to make their medical decisions.
  13. by   NightNerd
    They can refuse even when confused. It takes extensive discussion and work to be be able to medicate a patient against their will.

    As others stated, I try different tactics of convincing them to comply with treatment. If I can't educate or sweet-talk then into it, I'll leave the room and try again in a few minutes, by which time they're usually more receptive. If not, there is sometimes another staff member they're more likely to listen to, so I'll ask that person to try if they have a minute. If they're not putting themselves or anyone else in imminent danger, I do not force then to take anything; that betrayal of trust can really interfere with the patient's future compliance with treatment.
  14. by   Crystal-Wings
    You can't force a patient to take meds or partake in any treatment if they refuse, unless there is a court order.

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