Alert,oriented LTC patients who refuse routine nightly insulin? - page 2

by Blackcat99

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What is your LTC policy for alert oriented patients who refuse to take their routine ordered nightly insulin? She just says she doesn't want it and doesn't need it. What would you do?... Read More


  1. 1
    Educate and document! Inform your supervisor/DON so they can educate and document!
    Blackcat99 likes this.
  2. 1
    Quote from Blackcat99
    What is your LTC policy for alert oriented patients who refuse to take their routine ordered nightly insulin? She just says she doesn't want it and doesn't need it. What would you do?
    I don't need a policy, regardless of the type of facility, for an A&O person refusing a med/treatment/procedure. As others have said, educate/document/notify the PCP. I'm confused why this is even being asked.
    Blackcat99 likes this.
  3. 0
    Quote from Silverlight2010
    What kind of insulin would she be on that testing her sugar twice per week is sufficient?
    She gets lantus insulin every night. She took it tonight after I told her that I would have to call the doctor each time she refused. She said that she felt she was getting too much and I encouraged her to talk it over with her doctor.
  4. 1
    Depends on the medication. Patients have the right to refuse, but if they are refusing insulin, I would be concerned. One night probably won't harm them, but over a period of time insulin deficiency is a problem, as we well know. I would document, provide health teaching on the subject and inform the physician, the family, and the dietician. Together with the patient, we could revise her care plan. Ultimately, she can refuse, but I'm not willing to deal with an emergency simply because someone doesn't feel they need their insulin.
    Blackcat99 likes this.
  5. 4
    Quote from Blackcat99
    She gets lantus insulin every night. She took it tonight after I told her that I would have to call the doctor each time she refused. She said that she felt she was getting too much and I encouraged her to talk it over with her doctor.
    Her concerns are legitimate. In "people with limited life expectancy" an a1c goal of 8, rather than 6.5 or 7, is recommended in the literature due to increased risk of complications from hypoglycemia and less need to worry about long-term risks of hyperglycemia. However remember too that with insulin your choices are not just "give this full dose or don't give any." She may need a smaller dose indeed and a couple of fasting BG's would tell you that.
    Also if you are the nurse in the facility, it is your responsibility to talk to the doc about this, no?
    catlvr, KelRN215, Blackcat99, and 1 other like this.
  6. 0
    The doctor at this LTC is super good. He is here 4 days a week and visits his patients frequently. I talked to the Doctor yesterday about her refusing insulin sometimes and he asked me "Did she say why she refused? and I said she said she doesn't need it. He has not written any new orders yet in regards to her insulin.
  7. 1
    What are her sugars HS? Of course document, notify DON/MD. Teaching for pt is crucial.
    Blackcat99 likes this.
  8. 0
    She only has accuchecks twice a week as per MD's orders.
  9. 1
    I agree with the documentation and notifications listed above and would also add the DMPOA if that is activated.
    Blackcat99 likes this.
  10. 1
    Shoot let them end up in DKA and on endotool or some other algorhythm And the amount of sticks for blood sugar and the pain in the butt it becomes for them will teach them. Blindness and losing appendeges is way further than a good stent of DKA.

    Sent from my iPhone using allnurses.com
    joanna73 likes this.


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