What is procedure when patient is unable to take medicine?

Nurses General Nursing

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I've had two patients over the weekend who were unable to take ordered medication (one from nausea and the other deemed it unnecessary). In both cases I waited an hour and returned to try again. For this I'm in a bit of trouble :crying2:, and next time I'll consult immediately.

However my supervisor can't point to a written policy for when a patient refuses or is unable to take an ordered med. I agreed to work on this together with her.

Ideas? What is your written policy?

-Marnie

OK I think we've drifted away from creating a written procedure to talking about patient's rights :)

Which is a very valid issue, but not what I'm looking for here :)

Where I need help is in coming up with a written care standard for when it's necessary to consult with the doctor when the patient is unable to take a medication.

Of course what I'd really like to know is... What is YOUR organizations' written policy describing the procedures when a patient is unable to take a med? Can you share it?

-Marnie

The beginning of this instructional video shows the "best evidence" method of delivering the medication.

Numerous other lessons are presented for your instructional pleasure.

Pay particular attention to denture repair at 1:44.

Love it! LOL

Specializes in Emergency & Trauma/Adult ICU.
Thank you for the encouragement. The policy she's looking to put in place has to do with when to consult when patient is unable. There is judgment, and then there is practicing! So in some ways, I agree with my supervisor that a policy should exist to help us operate.

It was surprising that the hospital didn't have one for this, given that they do have policies for... blanket folding :). In the end I want to work within the standard - and if it's undefined, I'll volunteer to outline it.

I'm very surprised to learn that you are working in an acute care hospital. From your initial post, I had assumed this was an LTC situation.

I'm trying to better understand your situation. In an acute care setting, if a patient "refuses" meds due to nausea ... wouldn't you be contacting the physician anyway, to report the nausea, explore possible causes, and get orders for some intervention to relieve the nausea? I suspect that that is why the physician and nurse manager are upset.

In other words ... if my patient is nauseated, whether or not he got his 8pm med is the least of my worries if that nausea is a symptom of, say, an evolving cardiac event, or bowel obstruction. And even if it's fairly benign nausea (if there is such a thing) ... I'm not just going to allow the patient to remain nauseated while I wonder about the wording of documenting that he/she "refused" a med.

Specializes in Critical Care.

Our policy is that Pharmacy can switch routes when appropriate, although I agree with Altra that unexplained nausea might deserve a call on it's own. For patients who refuse a medication, our policy is to assess for why the patient is refusing, and to notify the MD and explore alternative "when appopriate". In other words, you don't need to call the MD at 0530 to tell them that a patient refused their protonix when they have no Hx of GERD and they have no systems or Dx related to treatment with a PPI, but you may need to notify the MD if a patient refuses IV heparin when admitted for a PE. That doesn't mean the MD can then override the patient's refusal, but it gives them the opportunity to speak with the patient or try alternative therapies that the patient accepts.

This is super helpful Muno - Thank you!

...if a patient "refuses" meds due to nausea ... wouldn't you be contacting the physician anyway, to report the nausea, explore possible causes, and get orders for some intervention to relieve the nausea? I suspect that that is why the physician and nurse manager are upset.

I will now! In this specific case, the patient was nauseated coming out of post op sedation. MD was aware of nausea.

I'm getting the idea that some judgment is required on when to consult depending on the critical nature of the order. In this case, with a risk of DVT, (and in hindsight) I should have consulted immediately. I think I'll write up that the maximum wait is one hour after a retry of any order, and the first time if it is a preventative med.

Does this line up with your policy?

Specializes in ICU.

It is your responsibility to notify the physician if a patient cannot/will not take an ordered medication. Especially something like coumadin. The doctor can then offer a substitute, if need be. We don't have a written policy for this; your nursing judgement can help you determine if the doctor needs to be called or not, depending on the specific medication and the patient's diagnosis. If the patient did not take the coumadin, the doctor cannot adjust the dose because the pt/inr will not be right. If the medication is something like colace or mucinex, then just chart they refused it. Whatever is done, it must be charted to protect you.

It is your responsibility to notify the physician if a patient cannot/will not take an ordered medication. Especially something like coumadin. The doctor can then offer a substitute, if need be. We don't have a written policy for this; your nursing judgement can help you determine if the doctor needs to be called or not, depending on the specific medication and the patient's diagnosis. If the patient did not take the coumadin, the doctor cannot adjust the dose because the pt/inr will not be right. If the medication is something like colace or mucinex, then just chart they refused it. Whatever is done, it must be charted to protect you.

Thank you applewhite - this is very much in line with what I was looking for :redbeathe

-Marnie

Specializes in Palliative.

to follow up on the first question, what if the pt is mentally ill and suffers from: depression, schizophrenia? i realize the pt has the right to refuse however, what if they are not thinking clearly due to their ilness?

Specializes in Emergency & Trauma/Adult ICU.
to follow up on the first question, what if the pt is mentally ill and suffers from: depression, schizophrenia? i realize the pt has the right to refuse however, what if they are not thinking clearly due to their ilness?

In the US, this varies based on the patient's status at the moment -- are they currently admitted to the hospital voluntarily? If so, then they most likely have the right to refuse any and all treatment.

If the patient is currently admitted under some type of court-ordered treatment for mental illness, then the laws of that specific state apply (and they do vary also). In my state, even a patient who is currently legally involuntarily admitted for say a 30-day inpatient course of treatment who is refusing meds requires 2 physicians to evaluate and go through a brief legal proceeding to "force" the administration of meds.

Specializes in Acute Care Cardiac, Education, Prof Practice.

Someone might have said this already, but Coumadin is a tricky one. Especially if you are loading a patient so they can go home. One dose can often be the difference between going home the next day, or not.

Sounds like you are getting the idea though :)

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