Alert,oriented LTC patients who refuse routine nightly insulin?

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  1. by Oct 14, '12
    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?
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    http://allnurses.com/showthread.php?t=792064

    by Blackcat99 Oct 14, '12 2:08 pm
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  3. 45 Comments so far...

  4. Oct 14, '12 by
    Really about all you can do is notify the physician about her refusals. Oh yes please also inform the unit manager, ADON and DON so they can follow up as needed. Of course, document, document, document.
    nhnursie, KelRN215, Hygiene Queen, and 3 others like this.
  5. Oct 14, '12 by
    Educate the patient...otherwise just notify the MD and document!
    KbmRN, IowaKaren, Blackcat99, and 1 other like this.
  6. Oct 14, '12 by
    What are her AM fasting sugars running? And her evening sugars? That is very important here. Can she be changed to a 24 hr insulin?

    I hate sticking myself - the injections, that is. But my morning sugars were way too high. So I am trying to be good, but it is difficult sometimes. I wish I had someone else to do my injections!

    As others have said, document, and notify everyone. Have the NP or doc talk to her. And what is her A1c? So many questions!

    Best wishes on this one!
    IowaKaren and Blackcat99 like this.
  7. Oct 15, '12 by
    Same as with any patients, no? Provide education about basal insulin (really, it's supposed to keep you feeling fine), and ensure that refusal is informed refusal.

    Also, as people age, insulin needs can lessen. Are you doing occasional fasting blood sugars and checking a1c's?
    Blackcat99 likes this.
  8. Oct 15, '12 by
    Thanks to all for your comments. She only gets her blood sugar tested twice a week as per doctor's orders. I don't know how often she gets blood work done. I will have to check it out when I get back to work this evening.
  9. Oct 15, '12 by
    take a witness with you, to document the refusal.
    Quote from Blackcat99
    Thanks to all for your comments. She only gets her blood sugar tested twice a week as per doctor's orders. I don't know how often she gets blood work done. I will have to check it out when I get back to work this evening.
    Blackcat99 likes this.
  10. Oct 15, '12 by
    I like to tell them a third party story. "I know getting insulin shots is a pain. Other patients have refused them too. The thing is, I've seen patients who didn't control their blood sugar and ended up having toes or even a foot amputated. They wished they had put up with the shots, what do you think?" Most of them take the injection.
    hey_suz, KelRN215, and Blackcat99 like this.
  11. Oct 15, '12 by
    document, document, document. and notify her provider as often as possible. Also education, and maybe offer to let her try it herself if she can. i know the pain of this!!
    Blackcat99 likes this.
  12. Oct 15, '12 by
    What kind of insulin would she be on that testing her sugar twice per week is sufficient?
    KelRN215 likes this.