Advice for Medication Administration

[PediNurseNYC]

Hi fellow school nurses,

I am currently dealing with an issue that has taken over my entire day at the school since the holiday break and really need some advice/insight.

I have a 10 year old student with Autism and is non-verbal. It has been such a struggle to give him his medication for months...and without this medication he is very dysregulated. In short, it is a power struggle: he has a voice, he can say no, and just doesn't take it. Eventually (after like 2 hours) he will give up and take it. 2 hours to give one medication to one student is just not a sustainable plan. So here is where I need your help...

Any out-of-the-box, creative ideas to med administration? He has a very limited diet, does not drink anything but water, and has extremely sensitive taste buds.

[OyWithThePoodles, RN]

Is this a pill or liquid?

[OyWithThePoodles, RN]

Just a thought:

Amazon.com: Oralflo Pill Swallowing Cup: Health & Personal Care

Of course, after one "tricking" he might catch on, but maybe he wouldn't even notice the pill going down.

[OldDude]

Is he in inclusion or in a life skills type class?

[tining, BSN, RN]

I made a calendar with the instructions of you take the med within 5 minutes and 5 days in a row and you get a prize.

I had a timer and stickers for the student to place on the calendar.

This student's reward was slime.

[WineRN]

He gets one medication at home (7 am) and another one in school (9:30a) per the order. He is refusing to take it at home also.

This is a hard one. In my district another school has a little one who refuses to take it at school, but will take it from mom, so the little one's mom comes in to administer it because he would not respond to any rewards system.

It sounds like if he is refusing at home, this may be more between the doctor and parent to figure out. I have 2 students here that sometimes refuse and I ask 3 times, document and go about my day because I just don't have the time for that

[tining, BSN, RN]

What is the med?

[ruby_jane, BSN, RN]

I have 2 students here that sometimes refuse and I ask 3 times, document and go about my day because I just don't have the time for that

YES!!! You are much more succinct than I am. OP is in a quandary because there's demonstrated benefit when the kid has the med, but hey...it's become a battle and an interaction from which the child is gaining something. Not sure what. But remember the movie "War Games?" The only way to win is not to play.

[lifelearningrn, BSN, RN]

Awkward question - does he have the right of refusal? It's an ethics question and I don't know the kid. Age 10 seems young to be able to refuse but I think a lot of that is dependent on individual district factors.

His right to refusal has certainly got to trump our right to force it down his throat. lol

[shark_nurse14, BSN, RN]

Been in a similar situation.... Mom suggested placing the med inside the hole of a raspberry! Works every time. The student noticed it was in there after the initial administration, but enjoys raspberries so much he takes it just to be able to eat the rest of the bag of raspberries.

[dinorn92]

I had a student who reacted similarly. We gave him his medication in a spoon of ice cream and usually had to show him his reward (his favorite candy) before he would comply. It still took about 10-20 minutes. His one on one also came along and promised time on the iPad after he was done....he always reacted better to her than he would if it were just me. Good luck!

[KelRN215, BSN, RN]

He gets one medication at home (7 am) and another one in school (9:30a) per the order. He is refusing to take it at home also.

G-tube.

In all seriousness, if the parent is allowing him to refuse the medication at home, how do they expect you to get him to take it? Limit setting with 10 year olds starts at home. Parents need to set the expectation that he needs to take his meds for them and for you.