working in psych...patient refused medication this morning, no agitation or anxiety, just clearly stated she is within her rights to refuse meds... so I did not give her morning meds. I continuously tried throughout morning, as I'm normally am able to convince pt to take, but not today...she steadfastly refused... Later, supervisor tells me that I must give her PRN meds via IM if she refused because she was hospitalized on a 302.... ... I checked the PRN meds IM and they state give for INCREASED agitation or anxiety--not for refusal of PO meds.... what is the right thing do?
May 19, '13
I'm assuming you're in PA since you used the term 302. I haven't worked in PA in a couple of years, so unless things have changed commitment (302) and forced meds are separate. Forced meds is a fairly easy process if the pt is clearly psychotic but does require documentation of a second MD's opinion. Once we had the second opinion the standing orders would read something like 5 mg Haldol PO BID, if refused 2 mg Haldol IM, by force if necessary. I worked in a prison setting though so I think we did forced more than standard inpatient. For sure, 302 does not equal forced meds though. I would look for a forced order or contact the MD for clarification. Emergency IMs can be given for imminent danger to self or others, not matter their inpt status, voluntary or committed.
Last edit by marshmallowstar on May 19, '13
May 19, '13
by Meriwhen, ASN, BSN, RN Senior Moderator
I'm not familiar with PA law and procedure, so I'm not sure what 302 is.
I can tell you that a psych patient, even an involuntary one, retains the legal right to refuse medication both scheduled and PRN. There are two times where that refusal can be overridden.
First, emergency medications can be administered without patient consent if the patient is an immediate danger to themselves or others. A patient throwing things at staff, trying to assault another person, or who is trying to cut their wrists with a pen cap qualifies for emergency meds. A patient who is agitated or angry but otherwise not hurting themselves or anyone else does not qualify.
The second time a refusal can be overridden is if there is a court order. This is not an immediate process, as it involves a petition being filed and a court hearing being held. Usually this is the time where orders will say, "if patient refuses PO, administer the medication IM." This court order is not to be confused with a temporary detention order or involuntary hold (we call them 5150s in CA)--such a hold does not mean we have the right to force meds against a patient's well. The court order to force medication is a specific--and not automatic--process.
As far as your patient goes, as long as she wasn't a danger to anyone, she could refuse the meds. Your supervisor's wrong on this count...in fact, if the meds were forced, the patient would be well within her rights to file a human rights complaint. And trust me, no facility wants to have to deal with that!
Last edit by Meriwhen on May 19, '13