Difficult resident

[dekatn]

I need advice about one of my pt. refusal to cooperate when taking meds. This pt. will put all pills in mouth and refuse to swallow, I have tried one pill at a time, I have tried crushing, I'm at my wits end. Pt. has 8 to 10 pills to take bid, it takes anywhere from 10 to 20 min. to try and cajole her into swallowing. This pt. can hold more water in her mouth than anybody I've ever seen, water and pill residue will run out the sides of her mouth, she can swallow, she just won't. Laughs, thinks it's funny. I just don't have the time to deal with this every day, day in day out, I'm afraid I just don't have the patience to deal with someone that thrives on aggravating the you know what out of staff just because they have always gotten away with it. I have tried being stern with her, kindness, bribery. Everybody that has ever given meds to her, say that is "just the way she is". Fine, but, I'm ready to start documenting that pt. refuses to take meds and be done with it. Pt. is A&O, CVA, no difficulty eating or drinking anything she wants, reg. diet, I'm fed up. HELP ME PLEASE!!!

[Nursebaby23]

I agree with Blackcat99. Don't beg and plead with anybody when you have to medicate other people. Throw them away and chart refused. What I can't stand is for somebody to waste my time and they know better. This is horrible to say but if she starts feeling bad then she'll know why.

[veteranRN]

This is certainly a behavior that needs to be tracked and care planned. I would plan an interdisciplinary team meeting including the family and resident and make a plan and then stick too it. Maybe offer 3 times then destroy and mark as refused. But be sure to track the behavior too. DOcumentation is your friend in this case.

[preciousshelby]

I work in a hospital and thank goodness I don't have 20 plus patients to pass meds etc. but what I do with my patients is if they start to refuse and they are alert and oriented I will go over the meds with them and what they are for, give them the opportunity to take them and if they refuse I will simply say "You are in the hospital and this is YOUR care, if you choose not to accept it it will reflect on YOUR recovery. I am not going to force you to take the medications but I will document this in order to protect myself and let your doctor know". Seems to work well with the ones that are on the edge "to take or not to take" and others who don't care about their care, well, at least they are aware that I WILL document this in their record as refused, that way when they go to the doctor and request "other meds" then the doctor is aware that they have refused all the other prescribed meds out of choice. (This also catches the drug seeking patients as well because if they refuse one pain med and not the other, it is documented)

[CoffeeRTC, BSN, RN]

Care Plan, Care Plan, Care Plan.....Need I say more...since this is LTC and surveyors love these types of issues, make sure you document and refer this to the IDT team. We don't have time to beg residents to take their meds.

[CapeCodMermaid, RN]

Hide 'em?????????? Zowie....even confused residents have the right to say NO to their meds and in my state it's illegal to hide pills. I've been a nurse for too many years to count and I've found that most of the time, the patient doesn't need at least half of the meds they're taking. Chart them as refused and call the doc.

[Antikigirl, ASN, RN]

I have had several patients do this..and this is when that 'art of nursing' we learned about really kicks in!

IN most cases I am dealing with someone that is either seiously depressed (and in denial of it), or feeling powerless until they found they can manipulate you! Here is what I did for most, and it doesn't work for all...but worth a shot I suppose.

I go in..and give ONE med to test the waters so to speak..if that isn't going well..I GET DOWN to eye level (being UP is intimidating) and ask them "is there a time that this would better fit your schedule?". You wouldn't believe the shocked looks I get..it is like "you are asking me what I FEEL???"...and normally I can convience folks to take them in 15 minutes or what not. Giving THEM the power can be so benificial..and us RN's can always reschedule a med or ask for an MD order at a certain time if need be.

If a patient totally declines...I give them that right and tell them (WITH A WITNESS and documented like no bodies business with quotes!) the ramifications of not taking their meds...I ask three times. If they decline three times I have done what I can and I can't force meds down their throats...it is a total decline at that point. If need be (which I normally do anyway) I notify the physician either by call (depends on med...not going to go calling for a colace or fish oil cap! LOL!) or fax that they have declined their medications...the situation (I will copy my care notes and send so I don't have to write it twice!). Then it is up to them...I keep trying what I can..but won't EVER force it on them...that isn't right..they do have the right to decline if they are of sound mind..if not..then the MD must set specific parameters!

ALso..check to see if liquid medications could help, or whether it is that huge Klor con hurting their throat..or the fact there are soooooo many pills is to blame..and work from there!!!!! That is a very very common thing!!!!!

Good luck to you!!!!!! :)

[xmaxiex]

I love when everyone else said to me "I have no problem with her she takes her meds for me !" Her A&O roomate stated to me more than once that she waits until nurses are out of the room and spits them out into the trash . Follow the above steps , refer to care plan team and document always !

[butterflynurse]

We have a patient and it's in her care plan to give her meds in the dining room with her meals. We mix her pills with small amounts of her food. I also had a patient that liked icecream and would mix her meds with small amounts of icecream and this worked wonders.