Pediatric/Adolescent refusal to take meds?

[NewEnglandRN, RN]

Hi,

What does your unit do if a pediatric or adolescent patient refuses to take their meds?

Thanks,

Michelle

[vrhodes]

On my adolescent ward we explain to the kids why they should take it, if they still wont,we write in the notes that they refused and get on the phone with their mum, usually the kids never win then!

Our kids with psych issues (generally eating disroders/ depression) if they refuse and their parents and DP/ case manager can't talk them around, they get placed under the Mental Health Act, and we then enforce treatment on them, meds given IM if possible.

[Meraki]

Hi Michelle

I work on an acute crisis child/adolescent unit and this is something we run into on occasion.

First we assess why they are refusing: is it paranoia/suspicion, is it related to stigma, is this a way for them to assert a small amount of control, are they generally oppositional and this is par for the course, is this a decision related to personal values...

Second we assess their capacity to fully understand the risks and benefits of the treatment. If they are deemed capable and still refuse, then that is their right, same as yours and mine. We will still continue to educate and involve the family who may be able to talk them into it.

If they are deemed incapable (either due to age, lack of judgement, disordered thougth process etc...) then we appoint a substitute decision maker who makes the decision. However this does not give us permission to force the treatment on them only to make it an expectation rather than a choice. Often these kids will take them with a lot of negotiation...ie let them choose who gives the med, when they take it, parents present, and other option we can give them..ie they'll only take it with chocolate milk etc...this helps them feel as though they are still part of the decision and eases some of their paranoid fears.

If they are incapable to consent and continue to refuse then it becomes a clinical judgement decision as to whether the benefits of the prescirbed medication outweigh the physical and psychological risks of restraint and forced treatment. If yes, then the patient must be made involuntary and then we restrain and IM.

Hope that helps

Jenna