What is procedure when patient is unable to take medicine?

  1. 0 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 , 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
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  3. Visit  Marnie S profile page

    About Marnie S

    From 'San Mateo, CA'; Joined Jun '11; Posts: 9.

    22 Comments so far...

  4. Visit  Sparrowhawk profile page
    10
    It's their right to refuse it, try again within the hour before/after and then circle it refused if they do it again.
    Tait, chelynn, maxandruby, and 7 others like this.
  5. Visit  SitcomNurse profile page
    13
    In all cases, re-appproach within 20-30 minutes, and report to next level supervisor the patients responses.
    Always notify the doc, in the case of nausea...
    Get an antiemetic order, and an order to have the meds taken 90 minutes(apx, use your judgement) after/within antiemetic.


    No matter what you do, they wont take the med?
    Declined to take the med (cognitively intact) and understands the consequences.
    Note that education provided, res continued to decline to take meds ordered by MD.

    Refused to take the meds(cognitively impaired) consequences shmonsequences...im not doing it until the dog is let out.
    Note that education attempted to patients comprehensive level, pt. continued to refuse the med.

    Rejected the med (cognitively intact) had been taking the med and now does not want to.
    Note that education was provided, and residents reason for stopping med is noted as well.

    Documentation and f/u. documentation and f/u. documentation and f/u.

    Tait, raincitynurse, maxandruby, and 10 others like this.
  6. Visit  loriangel14 profile page
    0
    It is not your fault if they refuse. Any patient has that right.In the case of nausea you could try an antiemetic before hand (in suppository form if needed). What kind of "policy" was she going to put in place? You can't force someone to take their meds.
  7. Visit  ParvulusPuella profile page
    1
    Depending on the medication, it may not be a bad idea to call and just let the doctor know.
    canoehead likes this.
  8. Visit  Esme12 profile page
    1
    Quote from SitcomNurse
    In all cases, re-appproach within 20-30 minutes, and report to next level supervisor the patients responses.
    Always notify the doc, in the case of nausea...
    Get an antiemetic order, and an order to have the meds taken 90 minutes(apx, use your judgement) after/within antiemetic.


    No matter what you do, they wont take the med?
    Declined to take the med (cognitively intact) and understands the consequences.
    Note that education provided, res continued to decline to take meds ordered by MD.

    Refused to take the meds(cognitively impaired) consequences shmonsequences...im not doing it until the dog is let out.
    Note that education attempted to patients comprehensive level, pt. continued to refuse the med.

    Rejected the med (cognitively intact) had been taking the med and now does not want to.
    Note that education was provided, and residents reason for stopping med is noted as well.

    Documentation and f/u. documentation and f/u. documentation and f/u.


    Great advice....this is pretty much standard of care. WHat is the policy at your facility. It matters if you did not follow the ploicy of you facility.....or your supervisor is a control freak. You should let the MD know in a reasonable amount of time depending on the med to obtain anit-emetic orders.....

    As above.......Document/F/U.....document/F/U/.....documentF/U....CYA.....
    Crux1024 likes this.
  9. Visit  Marnie S profile page
    0
    Quote from loriangel14
    ...It is not your fault if they refuse. Any patient has that right.In the case of nausea you could try an antiemetic before hand (in suppository form if needed). What kind of "policy" was she going to put in place?
    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.
  10. Visit  Marnie S profile page
    0
    Quote from SitcomNurse
    In all cases, re-appproach within 20-30 minutes, and report to next level supervisor the patients responses.
    Always notify the doc, in the case of nausea...
    Get an antiemetic order, and an order to have the meds taken 90 minutes(apx, use your judgement) after/within antiemetic.


    No matter what you do, they wont take the med?
    Declined to take the med (cognitively intact) and understands the consequences.
    Note that education provided, res continued to decline to take meds ordered by MD.

    Refused to take the meds(cognitively impaired) consequences shmonsequences...im not doing it until the dog is let out.
    Note that education attempted to patients comprehensive level, pt. continued to refuse the med.

    Rejected the med (cognitively intact) had been taking the med and now does not want to.
    Note that education was provided, and residents reason for stopping med is noted as well.

    Documentation and f/u. documentation and f/u. documentation and f/u.

    This is super helpful. Thank you!

    Is this your personal policy or based on a written standard?


    -Marnie


    P.S. In my first case, patient was cognitive, but unable to ingest Coumadin tab due to nausea. In the end, the patient didn't get the med at all and I didn't consult (nor did the next shift) which is where I think my biggest mistake was. Thus my penance of researching what policy is at other organizations or definition of standard of care.
  11. Visit  Marnie S profile page
    0
    Quote from Esme12
    ... WHat is the policy at your facility. It matters if you did not follow the ploicy of you facility.....or your supervisor is a control freak. .
    Thank you! She's enough of a control freak to do me good I think. Frankly I'm happy she's in charge and I think she's fair given the circumstances. Essentially they threatened that my failure to consult (and patient never got meds) bordered on practicing.

    I think we were all surprised that there isn't a policy or written procedure - or even written guidelines at our organization! Is this the case at your organization?

    -Marnie
  12. Visit  Whispera profile page
    1
    If someone is unable to take one form of a medication (nausea, inability to swallow, etc.) what about another form--suppository, sub-lingual, IM, IV?
    Ashley_RN likes this.
  13. Visit  ImThatGuy profile page
    0
    The beginning of this instructional video shows the "best evidence" method of delivering the medication.

    Numerous other lessons are presented for your instructional pleasure.

    http://www.youtube.com/watch?v=oyNnKYS29SY


    Pay particular attention to denture repair at 1:44.
  14. Visit  MunoRN profile page
    1
    Quote from Marnie S
    This is super helpful. Thank you!

    Is this your personal policy or based on a written standard?


    -Marnie


    P.S. In my first case, patient was cognitive, but unable to ingest Coumadin tab due to nausea. In the end, the patient didn't get the med at all and I didn't consult (nor did the next shift) which is where I think my biggest mistake was. Thus my penance of researching what policy is at other organizations or definition of standard of care.
    The patient's right to refuse a medication is a legal standard rather than a personal or facility standard, forcing a medical treatment on to a patient who refuses and is cognitively able to do so is considered abuse.
    chelynn likes this.
  15. Visit  Marnie S profile page
    0
    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
    Last edit by Marnie S on Jun 6, '11


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