Confused about hiding meds

[Theone40]

heres the situation I'm a new LVN working at a nursing home. we have pt that is bipolar she is suppose to take quetiapine in the morning and evening, well she always refuses her daytime dose because she says it makes her sleepy...today our DON said that we could put it in the food and just document " given with food" .....this doesn't sound right to me ? from what i learned in school you cant just hid meds in food without the pt knowing.......any help would be appreciated

[caliotter3]

When I worked in long term care, right or wrong, it was done all the time. I am not aware of any situations where it was done in direct contravention of the patient's wishes. If she complains of an untoward side effect, this should be documented and discussed with the doctor. She has the right to refuse. You really should be above board with this.

[LDBRN]

Sounds unethical based on the info you have provided.

[canoehead, BSN, RN]

I wouldn't do it.

[NurseCubanitaRN2b, BSN, RN]

I would continue to offer it to her and if she refuses, then mark it down as refused. IMO, if I was asked to put in in the food if she refused I wouldn't do it because to me it's deceitful. If she doesn't want it she doesn't have to take it. This should be brought to the attention of the doctor and depending on the med maybe she can have a lighter dose. Good Luck

[morte, LPN, LVN]

if the patient is"committed"/legally adjudicated (sp) incompetent....then perhaps.....Roger'd or Baker Act'd cant remember which applies.....even then i would think you would need a docs order....but the bottom line is she isnt refusing the med, only the daytime dose....why cant some adjustment in time be made to gain her willing compliance?

[fiveofpeep]

yeah she has to be ruled incompetent by the court before you can force the med. some people may even be involuntarily committed, but remain competent until a second court decision of competency is made.

[CaliAliRN]

I think the only time it ethically ok to give a medication without the patient's direct consent is if consent to give it is given by a parent/guardian (e.g. mixing crushable tablets in apple sauce). But even then, it is kind of iffy because once a child is able to conceptualize what the medication is and what it does to them, they have the right to refuse it.

This sounds very sketchy and unethical. No matter what the patient's mental state, he or she has the right to refuse. Chemical restraint is a very touchy, controversial subject that needs to be monitored and regulated because of the dangers it could have, even with psych meds, which are being given to hopefully elevate the psychiatric concerns. Like what everyone else is saying, get a doc consult and do what you feel is right for your patient.