Alert,oriented LTC patients who refuse routine nightly insulin? - page 4
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
Oct 17, '12Interesting interesting interesting convo. As with many decisions it boils down to "protect the patient or protect your license?"
On one paw I say follow facility policy and doctor's orders no matter what. Make sure to get crystal clear orders from MD & discuss plan with DON, and stick to that.
On the other paw, I wouldn't want to deal with a DM patient on my panel going into shock, the ED or dying on my shift and having MY name on the dotted line that I didn't admin insulin as the cause.
Wonder what a medical ethicist would say. Or a geriatric specialist MD.
Oct 17, '12We have residents who refuse various orders/treatments. After discussion with the resident, the family, and their physician, the resident, physician, family member, head nurse sign a detailed form that outlines their refusal of such treatment, and that the risks/ benefits have been explained to applicable parties. Furthermore, not following such treatment may result in injury, sickness, or death, and we, the facility are not responsible. The form is at the front of their chart, signed, and is periodically reviewed.
Oct 17, '12I am not sure many understand what it means to have 49 people to pass Meds on and educate. Day shift and management really need to be involved. The DON and case manager along with poa and MD. The nightshift nurse has to pass Meds and fly around like a maniac with little to no help. Here in fl we have " med techs" that pass Meds but do not administer them. They use a MOR (medication observation record) vs MAR and help keep the LPN on time but only the LPN can administer insulin. The facility I worked in only had 2 RN's come in to draw up the insulin for the Lpn's. It's crazy to think Brandon has in any way sherked his duty. This resident is not an inmate, they are living in their home but their home happens to be in LTC. If admin and the doc along with the family/poa cant fix it, how can the nightshift LPN?
Brandon if the guy says he wants 7u and you happen to administer the ordered dose, so be it. You are following orders and not lying as long as you don't say to the resident, "I am giving you the 7u you asked for"
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Oct 17, '12Brandon is right that you can't change the ordered dose if it is scheduled and not sliding scale. It's either all or nothing.
Oct 17, '12You could give less than the ordered dose (patient is allowed to refuse "some" of their medication) - but again it's not as simple as just giving less insulin and charting it. You'd still be obligated to notify the MD/POA etc. ad nauseum.
Oct 19, '12I think educating the resident as to why is is needed is a good start. As you know, never force it on the resident. If they still don't accept then report it to the charge nurse and make sure it is documented
Oct 26, '12Notify appropriate parties as per facility protocol (and common sense + your judgment) and document! Try different tactics to teach/encourage med compliance if her nightly insulin is truly necessary as per her nightly and morning sugars. Check her last HgbA1C.