Alert,oriented LTC patients who refuse routine nightly insulin?

Specialties Geriatric

Published

You are reading page 4 of Alert,oriented LTC patients who refuse routine nightly insulin?

CrunchRN, ADN, RN

4,530 Posts

Specializes in Clinical Research, Outpt Women's Health.

I agree with what you are saying to a point with regard to not having the time to debate/educate/call MD every night.

However, if a person is in LTC because they are physically unable to care for themselves, but are mentally competent (even if somewhat loopy to your thinking) then it is their choice.

At that point the doc should be discussing it with them and then if they don't want it or want less and are mentally competent then the order should be changed.

Maybe they are ok with dying at some point from high BS. Shouldn't that be their choice? Why should they be forced to maintain a healthy BS and thereby live much longer when they are already at a nursing home.

Look, I know you all work so hard to take great care of the residents under really impossible circumstances. However, for me, this lack of regard for my own ability and right to make my own choices and deal with the result is just horrifying. Horrifying.

BrandonLPN, LPN

3,358 Posts

Well, I don't think we're talking about the same kind of resident here. If someone *really* understands the consequences of refusing treatment and they are willing to face the consequences (ie death) then I agree with you. The kind of residents I'm talking about simply have deep emotional/personality/whatever problems that skew any sort of judgement. Their behavior is linked more to delusion and a desire to cause conflict than anything else. Totally different from the pt you describe who is institutionalized strictly due to physical handicaps but can still make rational decisions re: his medications.

CrunchRN, ADN, RN

4,530 Posts

Specializes in Clinical Research, Outpt Women's Health.

I am glad you can tell the difference.

Specializes in CCM, PHN.

Interesting 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.

joanna73, BSN, RN

4,767 Posts

Specializes in geriatrics.

We 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.

tamadrummer

150 Posts

Specializes in 1st year Critical Care RN, not CCRN cert.

I 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"

Sent from my iPhone using allnurses.com

SRK77

43 Posts

Brandon is right that you can't change the ordered dose if it is scheduled and not sliding scale. It's either all or nothing.

VANurse2010

1,526 Posts

You 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.

LJohnson11213

36 Posts

Specializes in NICU.

I 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 ;)

AngelRN27

157 Posts

Notify 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.

+ Add a Comment