Alert,oriented LTC patients who refuse routine nightly insulin?

Really about all you can do is notify the physician about her refusals. Oh yes please also inform the unit manager, ADON and DON so they can follow up as needed. Of course, document, document, document.

Educate the patient...otherwise just notify the MD and document!

What are her AM fasting sugars running? And her evening sugars? That is very important here. Can she be changed to a 24 hr insulin?

I hate sticking myself - the injections, that is. But my morning sugars were way too high. So I am trying to be good, but it is difficult sometimes. I wish I had someone else to do my injections!

As others have said, document, and notify everyone. Have the NP or doc talk to her. And what is her A1c? So many questions!

Best wishes on this one!

Same as with any patients, no? Provide education about basal insulin (really, it's supposed to keep you feeling fine), and ensure that refusal is informed refusal.

Also, as people age, insulin needs can lessen. Are you doing occasional fasting blood sugars and checking a1c's?

Thanks to all for your comments. She only gets her blood sugar tested twice a week as per doctor's orders. I don't know how often she gets blood work done. I will have to check it out when I get back to work this evening.

take a witness with you, to document the refusal.

Thanks to all for your comments. She only gets her blood sugar tested twice a week as per doctor's orders. I don't know how often she gets blood work done. I will have to check it out when I get back to work this evening.

I like to tell them a third party story. "I know getting insulin shots is a pain. Other patients have refused them too. The thing is, I've seen patients who didn't control their blood sugar and ended up having toes or even a foot amputated. They wished they had put up with the shots, what do you think?" Most of them take the injection.

document, document, document. and notify her provider as often as possible. Also education, and maybe offer to let her try it herself if she can. i know the pain of this!!

What kind of insulin would she be on that testing her sugar twice per week is sufficient?

Educate and document! Inform your supervisor/DON so they can educate and document!

What is your LTC policy for alert oriented patients who refuse to take their routine ordered nightly insulin? She just says she doesn't want it and doesn't need it. What would you do?

I don't need a policy, regardless of the type of facility, for an A&O person refusing a med/treatment/procedure. As others have said, educate/document/notify the PCP. I'm confused why this is even being asked.

What kind of insulin would she be on that testing her sugar twice per week is sufficient?

She gets lantus insulin every night. She took it tonight after I told her that I would have to call the doctor each time she refused. She said that she felt she was getting too much and I encouraged her to talk it over with her doctor.