Alert,oriented LTC patients who refuse routine nightly insulin? - pg.2 | allnurses

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

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. Visit  joanna73 profile page
    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.
  2. Visit  SHGR profile page
    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.
  3. Visit  Blackcat99 profile page
    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.
  4. Visit  KbmRN profile page
    1
    What are her sugars HS? Of course document, notify DON/MD. Teaching for pt is crucial.
    Blackcat99 likes this.
  5. Visit  Blackcat99 profile page
    0
    She only has accuchecks twice a week as per MD's orders.
  6. Visit  NutmeggeRN profile page
    1
    I agree with the documentation and notifications listed above and would also add the DMPOA if that is activated.
    Blackcat99 likes this.
  7. Visit  tamadrummer profile page
    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.
  8. Visit  BrandonLPN profile page
    2
    I know I'm going to get blasted for this, but I have a similar pt who has an order for 15 units of novolog with meals. He is alert and oriented, too. Every night he tells me to give him less than the 15. He always says "give me 7 units tonight" or something like that. I say "okay" and give him the 15 units anyway. What he doesn't know won't hurt him. And the doctor knows I do this and finds it amusing.
    joanna73 and Blackcat99 like this.
  9. Visit  CrunchRN profile page
    2
    I think an alert and oriented person who is trapped in a freaking nursing home should be allowed to make their own choices as long as they understand the implications.

    God save me from well intended people making those decisions for me. I would rather be dead any day.
    catlvr and Blackcat99 like this.
  10. Visit  BrandonLPN profile page
    1
    Quote from CrunchRN
    I think an alert and oriented person who is trapped in a freaking nursing home should be allowed to make their own choices as long as they understand the implications. God save me from well intended people making those decisions forme. I would rather be dead any day.
    If you won't follow the doctors treatments, what's the point of even being IN a nursing home. If these people were capable of making these kind of decisions they wouldn't be here in the first place. By definition of their being here they can't take care of themselves....
    Blackcat99 likes this.
  11. Visit  CrunchRN profile page
    0
    Well. I wouldn't be there by my own choice, but we all know that many people become disabled eventually due to age and infirmities and you will be "put" in a nursing home whether you want to or not if unable to care for your self and no family available.
  12. Visit  BrandonLPN profile page
    0
    I get your point, but I still don't think that not allowing residents to dictate their medication regimen is a violation of their rights or something. I mean, society has legally decided you are incompetent to live on your own, but it's okay for you to decide which meds to take and which not to? That never made sense to me.
  13. Visit  Meriwhen profile page
    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?
    If she's AO4 and legally competent, then there is nothing you can do to force her to take it. Document every refusal, let the MD and management know, and keep trying to educate her.
    Blackcat99 likes this.


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