Patient lied about dose change

VTLegalRN · Feb 3, 2016

Hello chiiou0706, and welcome to home care! Critical? I don't think so. As a general rule, the patients are self-directing in home care. Be truthful in the record about the actual doses taken during that time. It should be documented what the patient told you about the "change", and that you reached out to the physician and left a message. The medical record just needs to reflect the med changes as they occurred, the reasons why, and the collaboration with the physician surrounding it.

The supervising RN on the case should be aware and together you may discuss with the patient the reasons behind wanting to cut down on this med. By having an open discussion with the patient, you may get to the root cause of the issue, address it with the physician and in the care plan as needed. Perhaps the patient is experiencing a side effect she doesn't like.

In home care, as in any other setting, MD orders for every medication taken, even over-the-counter meds and supplements. When the client reports a change, we do our part to follow-up with the physician for the new orders. Chances are, it won't be the last time you'll find a discrepancy. To avoid this in the future, you can equip your patient with a communication notebook. You can also have the doctor confirm any med changes directly on an interim order sheet or Rx note.

I hope this helps to allay some of your anxiety. If you get to the "why" the patient lied about her visit and dosage change, do share! We learn from each other.

Regards,

VT

Crystal-Wings, LVN · Feb 3, 2016

I would ask for another case. If a patient is gonna lie about their medication dose change, they're likely to lie about something else or accuse you of something you didn't do. Your license isn't worth losing over something like that!

VTLegalRN · Feb 4, 2016

I would ask for another case. If a patient is gonna lie about their medication dose change, they're likely to lie about something else or accuse you of something you didn't do. Your license isn't worth losing over something like that!

This is not uncommon in home care. Your license is not at risk because a patient is being untruthful. This is a behavioral health case. It's why we're there! The key is accurate documentation and reporting, so that there is a team approach to managing the issue. These patients establish patterns, that's why the team approach is important.

A good manager knows how to address this. I've heard it all... all kinds of concocted stories throughout my career. I've often thought jokingly of writing a book of these experiences. In fact, maybe I will! :wideyed:

JustBeachyNurse, LPN · Feb 6, 2016

You don't take dose changes from patients or parents. You ALWAYS verify with provider/physician or pharmacist. If you were working inpatient psych would you take a patient's word for a dose change?

Talk to the nurse manager. Never take orders from patient or family. Always verify from physician or in a pinch can check with pharmacist. Document. While not a critical error it is an incident report/medical error. You did not follow the standard of care by taking medication or any orders from a patient/family. Discuss it with your supervisor

doodlebuttRN · Apr 10, 2016

You don't take dose changes from patients or parents. You ALWAYS verify with provider/physician or pharmacist. If you were working inpatient psych would you take a patient's word for a dose change?
Talk to the nurse manager. Never take orders from patient or family. Always verify from physician or in a pinch can check with pharmacist. Document. While not a critical error it is an incident report/medical error. You did not follow the standard of care by taking medication or any orders from a patient/family. Discuss it with your supervisor

Like JBN and VTlegal said, nurses cannot take verbal orders from patients/caregivers. If your patient reports a dosage change, I would contact the provider for a verbal/ telephone order) your agency should have a form for verbal/telephone orders. Make sure you know follow your nurse practice act for taking telephone/verbal orders as an LPN)or written (faxed) order. I wouldn't make any change to the MAR without it.

Contact your supervisor if you aren't sure how to carry this out correctly. Patients and TCGs/family members often can't remember all the "rights"'of a proper order. This is just one reason to clarify with the provider.

If the patient gives you a hard time about calling, stand your ground. They don't understand nor appreciate your responsibilities as a nurse.

If the state audits your case, "the patient told me to" won't hold water for even a minute.

I know these patients can be intimidating, and demand things their way. Remember, control is huge in HH/PDN. Allow the patient to retain control where appropriate. Don't allow yourself to be comprised for their convenience. You've worked far too long and hard for that.

Best of luck.

caliotter3 · Apr 10, 2016

I worked for a couple of agencies that allowed nurses to take orders from a family member. But this was only for certain family members who were known to report accurately. All other protocol was followed as usual. If I had any concerns about the order, I would follow up as I normally would anyway. There were never any problems that I can recall, probably, because nurses only took orders from family members who were known not to give inaccurate information.