Can a patient refuse PART of her medication dose?

Nurses Safety

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I work in a Juvenile Detention Center. One of my kids takes Trileptal 300mg...her bottle says she takes 2 at night, but she says that she takes 1 pill. She does not refuse her medications, just refuses to take 2 pills.

I have told her that it is her right to refuse her medications, and if she believes she only takes one pill at night, to refuse the other pill.

Meanwhile I have been trying to get ahold of the kid's doctor to clarify the order.

The evening LPN won't give her a partial dose. She called the Pharmacy last night and they told her that it was 'Prescription Fraud' to administer partial dosages, that the medication had to be administered exactly as prescribed or not at all.

I haven't been able to clarify this particular patient right. Anyone know??

nadjjaa, RN

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Specializes in ICU/ER.

I would just call the Dr and tell him that pt is only taking half dose and refusing the other half. Either he will give you an order for half dose or provide you with the logic behind the full dose so you can then educate her on the need for full dose. I am betting he will just give you order for half dose.

I am not familiar with that med though...but think about our pain med orders they are 1-2 prn, then we break it down further, if pts pain is 1-4 out of 10 they get 1 pill if pain is 5-10 out of 10 they get 2.

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Specializes in Cardiac.

By giving a partial dose, you are practicing medicine without a license. You need to contact the Dr and get the order changed.

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My understanding has always been that it's "all or nothing," as the pharmacist told your LPN -- you either give the med or you don't. The client can refuse the med, but then s/he is refusing all the med. If the client is choosing to only take a partial dose, and you are giving only a partial dose, then one or the other of you is prescribing, which neither of you is legally authorized to do. And, as you note, the best nursing response is to consult the Rx-ing physician about getting the dose changed to something the client is willing to take.

Now, if you're giving the med and the kid swallows one pill and then refuses to swallow the other, there's nothing you can do about that after the fact :), but I would document that as an occurrence and, the next time, wouldn't give the med at all if the kid's not willing to take the entire dose.

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By giving a partial dose, you are practicing medicine without a license. You need to contact the Dr and get the order changed.

I would say that was true if I was only offerring her a half of a dose, but I'm offering her the FULL dose and she is REFUSING part of it. So it is not practicing medicine without a license, lol

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I would just call the Dr and tell him that pt is only taking half dose and refusing the other half. Either he will give you an order for half dose or provide you with the logic behind the full dose so you can then educate her on the need for full dose. I am betting he will just give you order for half dose.

I am not familiar with that med though...but think about our pain med orders they are 1-2 prn, then we break it down further, if pts pain is 1-4 out of 10 they get 1 pill if pain is 5-10 out of 10 they get 2.

God word back from the doc, the dosage is as it is on the bottle, but they are telling me to give one pill if that is all she will take. They're telling me I'm not violating anything, that the patient has the right to refuse all or part of her dose. Apparently I'm violating more rules if I withhold the medication.

I would like to have this "right" in writing....

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Specializes in ICU/ER.

If Dr told you to just give one pill, then write that as a telephone order. And fax it to pharmacy. I am assuming you repeated and verified that statement?

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Specializes in Cardiac.
I would say that was true if I was only offerring her a half of a dose, but I'm offering her the FULL dose and she is REFUSING part of it. So it is not practicing medicine without a license, lol

Why do people put questions up and then get angry when they get responses? :confused:

If you are giving the pt a dose that isnt' specified on the MAR, then YES, you are practicing medicine without a license.

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Specializes in Med/Surg, Telemetry.

Just make sure you document that the MD gave you permission to only administer half the dose. Also, i'd call the the MD back and tell him you need a new order. :yeah:

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Specializes in Cardiac, ER.

It comes in a 600mg tab,...maybe he should write for that and then she'll only have to take one tab!! :uhoh3:

I have frequently had adult pts "correct" me with medication doses. "I used to take two of those at night but my Dr cut it in half because...." usually this is simply a mistake on the MAR because the home med list wasn't updated as it should have been on admit, a quick note to the Dr and it's fixed the next night. I would never give more med than the Dr wrote for, but I have many times allowed a pt to refuse that second pill. Not sure how that would work with kids though,.although what are you gonna do,..hold the kid down and force it down her throat?

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Specializes in Peds, PICU, Home health, Dialysis.
Why do people put questions up and then get angry when they get responses? :confused:

If you are giving the pt a dose that isnt' specified on the MAR, then YES, you are practicing medicine without a license.

I do not think it is "practicing medicine w/o license". If you don't give the med at all (if the pt. refuses it), then you are technically giving a dose not specified on the MAR. I don't see the difference.

Nurses I have worked with on the floor have given different doses if the patient refuses the full dose. The nurse of course will always follow up with the doctor and give them the situation and get a dosage change.

But I would think when working with a minor it would be different.

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Specializes in Cardiac.

It's also a med error, since the correct dose was not given.

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