Patients Refusing Care, then self-medicating

[blondy2061h]

How can you handle patients self-medicating? I just read this blog entry.

A long time ago, I remember being in the hospital for something unrelated and having the attending tell me I was no longer injecting while I was inpatient. She started figuring out my doses by my weight or some such madness..and I flew up over 200 and sat there. They fed me sugar free stuff...all low carb...and aspartame gives me migraines. They didn't have a clue. After a few hours, I declared that I would be handling my diabetes care and that they needed to stay out of it. I had to sign some "against doctor advice" piece of paper, but my BG went back down to 120 as soon as I dictated my basal rates. Patients: don't ever forget that you have the right to deny care!

Obviously anyone has the right to deny care, but, there's a difference between denying care and downright self medicating while in the hospital.

I've worn my insulin pump while inpatient in the hospital before, but that was after the hospitalist and nurses were aware I was wearing it, and informed of my insulin rates and such, and agreed that was the best idea.

Insulin is one thing, would it be different if a patient decided to self medicate with Xanax or Dilaudid while in the hospital?

But then what recourse do you have from that? Can you take something away from them that they have a prescription for and own and brought from home?

[regularRN]

I know people who titrate their own psych meds - if such a person was admitted to hospital, I think we should respect this because only they know exactly how they feel.

[firstyearstudent]

I think there is a big difference between letting a patient who has a long standing condition like diabetes manage it themselves in the hospital and letting patients take controlled substances in the hospital. While insulin does have risks, they would probably be minimal and the nurse could monitor the patient's therapy by either taking their own BS checks or asking the patient to share their information. On the other hand, medications like Dilaudid and Xanax are often abused and can lead to falls.

The problem I recently ran into was with patient who wanted it both ways. I had a sliding scale for R insulin and she insisted that I give her 2 extra units because she was eating pancakes for breakfast. She'd been managing her diabetes well for over 10 years and I'm sure she was right about it, but I couldn't give her two extra units without a doctor's order.

Now that I have G.D. and am taking insulin I can see how it makes more sense to have an experienced patient manage their own diabetes rather than doctors and nurses who don't have any where the same level of knowledge of the patient's particular metabolism, diet and eating habits.

[blondy2061h, MSN, RN]

What if the doctor decides they shouldn't be self medicating and they still are? What can be done about that?

[morte, LPN, LVN]

What if the doctor decides they shouldn't be self medicating and they still are? What can be done about that?

document, educate, inform (doc)..... rinse and repeat