Medication administration vs Patients wants

[Notmarvin]

I am a brand new RN of two weeks and have run into an issue I cannot get a clear answer on. I work on a very challenging Med-Surg unit and have had one day of orientation with a preceptor and am now pretty much on my own. I have a pt who has been admitted for many months and waiting placement. My MAR shows she has dozen of meds scheduled between 0800 - 1100. I have worked with her for the last two days and each am she refuses all meds and demands to take them around 1030. I have been charting refusals and have dispensed the meds as 'patient request' at the later times. Other RNs on the unit say this is how she does them, they leave them bedside and she takes them as she pleases. I am uncomfortable with this as that I cannot keep track of when she takes them. I can recite the medication admin rights in my sleep but does patient desires trump those rules? Should I omit the am meds and refuse to give them when she asks for them late am, or give them when she will take them? Hoping to keep my license long enough to pay off my student loans I would love any help!

[HappyWife77, BSN, RN]

If they don't want them when you give them....tell them to let you know when it's better for them. And you will bring them back. Document and try to get the times changed that will be ok with them. It's really no big deal...As long as you stand your ground for your license by not leaving them and then documenting and notifying the doc. Also of coorifice educate the pt. related to the possibility of effects or interactions of their decisions to wait or not take them as scheduled.

We don't have all day to wait on people to take their meds.

[MunoRN, RN]

And hospice is one of them. Hospitals and other care areas where more than one person may have access to meds left parked on a bedside table, or where the opportunities for diversion or abuse, or where the possibility of aspiration or other mishaps exist (in an ongoing care milieu, not at home per hospice) are not.

Also, RN scope and standards of practice require us to follow safe med administration practices, including "right route," and there is ample evidence to suggest that this means you watch the patient swallow the meds you have poured.

There may be workarounds, as described above, but convenience for the nurse does not equal an imprimatur for unsafe or unprofessional practice.

I think you're throwing too large of a net. For the most meds and situations, this is true, not all. I've worked at three different hospitals that all had policies on leaving meds at the bedside, in that they defined when they could be left at the bedside. Moisturizing eye drops, saline nasal spray, and even rescue inhalers all have appropriate situations to be left at the bedside. We even had to promise the DOH at one point we would do a better job of leaving rescue inhalers at the bedside, so I don't think 'always' argument is really 'always' true.

[morte, LPN, LVN]

I learned in Jr high science the only time to use "never" or "always" was when you state you never said, never or always.....

[nurseprnRN, BSN, RN]

I think you're throwing too large of a net. For the most meds and situations, this is true, not all. I've worked at three different hospitals that all had policies on leaving meds at the bedside, in that they defined when they could be left at the bedside. Moisturizing eye drops, saline nasal spray, and even rescue inhalers all have appropriate situations to be left at the bedside. We even had to promise the DOH at one point we would do a better job of leaving rescue inhalers at the bedside, so I don't think 'always' argument is really 'always' true.

You are correct. I ought to have made it clear that things like EpiPens, rescue inhalers, and OTC saline and the like can or should be left where the patient can reach them prn as properly prescribed.

However, the OP was discussing oral meds that she had to prepare and bring to the bedside, and my opinion stands on that.

[toomuchbaloney]

I would submit that if a patient is hospitalized for, say; control of seizures, it would be inappropriate for the provider to write orders for those medications to be left at the bedside to be taken at the discretion of the patient. I doubt that anyone would disagree.

However, if the patient is hospitalized for, say; surgical stabilization of a fracture, and the patient requests autonomy with their routine seizure medications at the bedside, many of us would not have a problem with that. It is not in anyone's best interest, IMHO, for health care providers to be micro-mangers of those things which patients can have control. Some might argue, in fact, that true advocacy for the patient would suggest that we seek for the patient to have and retain control whenever possible in matters of their own health. In fact, some would go on to intimate that such patient control over their own health matters actually improves the mental and psychological health of those patients who have chronic disease states, when they encounter the acute care health system.

There is clearly room for difference of opinion in this matter. I think that the differences are often representative of how and where we have practiced as professionals.