Quote from kids-r-fun
I've encountered this with dialysis patients in LTC (and never got a good answer).
I understand that a mentally competent patient has the right to not comply with their diet and fluid restrictions (actually, an incompetent patient also has that right unless a guardian says differently).
I understand that very through documentation of patient teaching has to occur, detailing what the risks of noncompliance are and that they have been explained to the patient.
My question is are we then obligated to provide the food & fluids they request that are out of compliance?
Does their right to noncompliance obligate us to provide them the means act in violation of the physicians order?
(I worked, briefly at a facility that said yes. We had to do detailed documentation on patient teaching each time the noncompliant foods/fluids were requested and if the patient still desired we had to provide the food/fluids.)
I had the same problem w/ LTC pts on dialysis, and I also worked only briefly at the facility.
The place had non-compliant pts sign dietary and fluid restrictions waivers.
Here is a paraphrase of what the waiver stated:
"I know and understand the renal diet and fluid restrictions my doctor has ordered for me. I choose not to follow these restrictions, which is my right. I understand the health dangers, including death, which could occur as a consequence of me choosing not to follow prescribed fluid and dietary restrictions. I take full responsibility for any consequences, and choose to waiver my legal rights to sue the facilty or hold them responsible in any way."
The pts signed this document once, and then ate and drank however they wanted. We were required to give them whatever was available to eat or drink. I personally never directly handed a tray full of high K+ and phosphorus foods to a dialysis pt, as I did not feel comfortable doing this. I always handed these trays to someone else (who didn't mind) to give to the pts.
I also know that pts were never given their Phoslo with meals, as required.
This place had a lot of residents on dialysis, and every single one signed the waiver. The facility encouraged this, as they did not want to have to provide the renal diet$.
The place was a real hell-hole.