difficult family members refusing meds for patient

SoldierNurse22, BSN, RN · Apr 2, 2014

If a family member doesn't have any legal grounds to dictate the patient's wishes, then I would absolutely proceed according to the orders of the physician in an effort to restore normal function, prevent decline and relieve suffering.

I've seen this happen before. We had a patient who was dying and they had a relative who wasn't the DPOA, but kept trying to feed their mother (who had failed several swallow studies and was noted to be aspirating). After repeated attempts to educate, we eventually kicked them out of the room because they were deemed a risk to the patient.

Was the patient dying? Yep. Was it fair that they might die due to pneumonia instead of their cancer because of their family's actions? We didn't think so.

Been there,done that, ASN, RN · Apr 2, 2014

Two choices: give it after the family leaves it, prevents any conflict you don't have time for... or my personal favorite..

turf it to the doctor! They will not argue with the physician.

Here.I.Stand, BSN, RN · Apr 7, 2014

No DPOA for medical, no say in the matter. Now if they are not the adversarial-with-everyone type, and the pt is confused, I might ask why they don't want her to have the med. It could be that the pt has had some strange reaction to the med in the past that they didn't list in the allergies. I've had pt's who have reported diarrhea following small doses of bowel meds; the other day a colleague gave a dose of prn Ativan and practically had to peel the pt from the ceiling. But it's usually obvious who has legit concerns w/ a particular med, and who is adversarial w/ everyone and suspicious of everything.

For the pt who is A&O and not refusing meds, to the family member I will say that my obligation is to give the med unless the pt refuses it. If I'm not feeling like confrontation that day though, I'll conveniently decide that the pt needs privacy for something. I'll ask the family members to step out for a few, and then give the meds.

Ruby Vee, BSN · Apr 8, 2014

Press-Gainey dictates that you make even difficult, crazy or obstructive family members happy. But you can express concern that they've been at the bedside all day, must be exhausted and suggest that now might be a great time to go get a cup of coffee . . . and then give the med. Assuming, of course, that the visitor doesn't have a legitimate reason for refusing on the patient's behalf.

If you can't pry the family loose from the bedside, educate, educate, educate. Sometimes I'll have the provider talk to them, if you have the luxury of on-site providers. If the patient is with-it, go with their decision. (After appropriate education, of course.) If the patient has dementia, it's more difficult. I find I've had more issues with the family insisting that the demented patient be given some medication that they don't need and have been consistently refusing.

Susie2310 · Apr 8, 2014

My opinion is that if the family member (and I am assuming a close family member, who is involved in the patient's care, whether they are the POA/have decision making authority or not) is questioning the necessity/appropriateness of a particular medication, believing it is not indicated or is contraindicated, and is refusing a medication on behalf of the patient or is expressing objections to the patient receiving the medication, I think the first action to take is to listen to the family member. It is quite possible he/she may know more about the patient's medical history and response to medications than you or the physician does, and may play a big part in caring for the patient, and have a good reason for refusing the medication on behalf of the patient. But regardless of whether the family member appears to have grounds for refusing/objecting to the medication on behalf of the patient, I believe the initial correct action is to refer the situation to the physician and ask the physician to discuss the treatment plan with the family member and the patient (assuming the patient wishes for this family member to be involved in their care). It is possible there may be medical justifications for the patient not to receive the medication, if the family member provides more information/raises specific concerns with the physician. From reading risk management information regarding these types of situations, I believe this is the most appropriate first course of action.

dudette10, MSN, RN · Apr 22, 2014

Difficult family members trying to dictate medical care. Just love 'em!

Here's how the game is played: from the time you get report, the off-going nurse will fill you in on the sticky issues. Then, from the start, project confidence and competence. Explain everything without being asked, which we should be doing anyway. Make sure you are on time with your basic care, and enlist the help of the CNA with a heads up to him/her. Make a bathing and turning/oob schedule with the CNA in front of the patient. Give them the direct line to dietary during introductions so that you are no longer on the hook for the inevitable arguments about food. Ask the family their opinion on things. "I just want to make sure that your mom likes her pills crushed in applesauce. Or would she prefer pudding?" A lot of it is ass-kissing, but I'm not the least bit degraded by doing so if it saves me a raging headache later on!

Pick your hills to die on. I will usually let them get their way for things that aren't urgent. Other things, absolutely not, and I will explain why not. For example, I had a dtr throw a fit over the amount I was using to flush a feeding tube for her dad. It was the ordered amount. Turns out, she was using less than the order at home, and, you guessed it, he came in with hypernatremia, among other diagnoses. Once I explained that to her, she magically shut up about the flush amount.

This sounds all cynical and stuff, but also keep in mind that the family member, as difficult as he/she may be, knows the patient best. You really do need to listen to them when they say that something isn't going to work or if there is a change they are concerned about. It's a balancing act between their ******** and their knowledge.

exp626 · Apr 28, 2014

Here's just a thought, but maybe we should be screening the patient in this scenario for domestic abuse. My experience is that 99% of the time, the overbearing families are coming from a place of love and a desire to protect their loved ones from the evil medical establishment. A reminder to them that we're all here to get mom well, and how wonderful it is that she has such a supportive advocate, but now let's talk about why these meds/treatments are ordered, usually has the desired result. But it does bother me that the family was so vehement to make decisions for mom without giving her the opportunity to voice her opinion in her healthcare.

systoly · Apr 30, 2014

as others have said, listen to family members when the pt has had previous (negative) experiences with Rx

in this particular case I might have said something like, "how refreshing, finally someone who doesn't

believe all of life's problems can be solved by taking another pill" and then do exactly what OP did

Nola009 · May 11, 2014

I would tell that lady to eff off and take it up with the dr, that is if she's even the POA. And if not, then go take a hike.