Frustrating patients

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Specializes in critical care; community health; psych.

Yesterday I lost my patience with a patient. I didn't yell at her or become abusive or anything remotely like that, but I knew I had had it and had to excuse myself before I did say something I might regret. She was one of thse LOL that just couldn't get a grasp on her meds. She presented me with a list of medications and the medications which she kept in three different places. She said she was confused. I reconciled the list with the meds and tried to take away what she didn't need and combine the appropriate meds in one place. She wouldn't let me do that. Then I offered to fill her mediplanner. She wouldn't let me do that. Then I explained that she should only take what was on the list. She was still confused. We started over again. And again. Finally, I told her I was trying to help her but she wouldn't let me so I could do no more for her. I spent over an hour with her for a simple visit. What's scary is that she drives.

This underscores a problem I think we all encounter on a regular basis. Confused elderly who have no business being left to their own devices to be responsible for taking meds. We're in there for such a short period of time. What happens when we're gone? And then, despite our best efforts to try to organize things, they still manage to take the wrong meds. I hate it when they bring me boxes of medications and I have to sort through them and flush the old stuff away and they won't let me. I can see it coming. They're going to mess up. It's just so frustrating. Social services can only do so much.

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I ran into a version of this with my own Mom. I went over her meds and discovered that she was prescribed 6 times the recommended range of a med for her age. I asked her to bring it up with her doctor on the next visit. I also tried to organize and explain everything to her in an easy way for her to understand, but she kept telling me how terrific her regular nurse who visits her is and how she kept her things in order (I begged to differ). I could see I was getting nowhere. I accidentally left my med guide at her house. When I next visited and had occasion to take my mom to a couple doctor appts. I was surprised by the negative reactions. Apparently those who my mom was dealing with did not want any interference from the "nurse daughter". I looked at the prescription in question. It somehow had been mysteriously changed to a more appropriate dose. It was then that I wished that I could just convince my mom to come live with me so I could watch over her.

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Specializes in Hemodialysis, Home Health.

I have a LOL whom we will soon be discharging. She is a living DOLL. But she is on MULTIPLE meds, and there is NO WAY that I would ever trust her to set up her own medplanner box. She is horribly confused when it comes to her meds, nor does she have the eyesight to differentiate should some of the tablets fall out of the bottle onto the table, etc.

I really worry about this. She has no family who comes on a regular schedule who could do her weekly med set ups. She wouldn't even know how to call in refills.

What to do????? MCR won't justify keeping her just to have a nurse go in once a week and set up her meds... will they?

Are there any viable options ? Any advice?

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Specializes in critical care; community health; psych.
I have a LOL whom we will soon be discharging. She is a living DOLL. But she is on MULTIPLE meds, and there is NO WAY that I would ever trust her to set up her own medplanner box. She is horribly confused when it comes to her meds, nor does she have the eyesight to differentiate should some of the tablets fall out of the bottle onto the table, etc.

I really worry about this. She has no family who comes on a regular schedule who could do her weekly med set ups. She wouldn't even know how to call in refills.

What to do????? MCR won't justify keeping her just to have a nurse go in once a week and set up her meds... will they?

Are there any viable options ? Any advice?

It is a frightening prospect. No. MC won't pay for that but maybe a community agency can be tapped into like the VNA. In a situation like this, I would request a SW consult. Maybe there is a local agency for the aged that can provide this service. Of course a relative or trusted neighbor could be of tremendous help too.

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Specializes in Hemodialysis, Home Health.
It is a frightening prospect. No. MC won't pay for that but maybe a community agency can be tapped into like the VNA. In a situation like this, I would request a SW consult. Maybe there is a local agency for the aged that can provide this service. Of course a relative or trusted neighbor could be of tremendous help too.

All her neighbors are as elderly and in worse shape than she ! :o

And family members few and far between, living out of state.

But yes, we do have an onboard SW with the agency and she is the one I had planned on speaking with regarding this pt. Even now, before her recert period starts coming to an end.

VNA is a thought, too.. although I don't have any local experience with them at all.. don't even know if they have a local oraganization?

I guess I need to look that one up.. do my research, eh? ;)

Thanx for the suggestions !!! :)

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You know, this is a little off topic, but I saw on the news one time where in China a middleaged woman will take care of an elderly woman, and then when she gets elderly a middleaged woman will take care of her. I thought that was a great concept.

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Mulan

Just goes to show how far more advanced other cultures are compared to ours. We let our elderly and helpless live in the streets in some instances.

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Specializes in LTC/hospital, home health (VNA).

Sometimes the office of aging will fund programs through the local VNA/home health agency that can help with med prep... along with CV checks, BP clinics, etc. A SW consult is a great place to start. I know that does not take the frustration factor out. I once spent close to 2 hours undoing a med box that the patient had attempted to do on her own, identify all the pills, clarify with the doc, then refill it properly!!!

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Specializes in Hemodialysis, Home Health.
Sometimes the office of aging will fund programs through the local VNA/home health agency that can help with med prep... along with CV checks, BP clinics, etc. A SW consult is a great place to start. I know that does not take the frustration factor out. I once spent close to 2 hours undoing a med box that the patient had attempted to do on her own, identify all the pills, clarify with the doc, then refill it properly!!!

All kinds of good info and suggestions here! Thank you so much ! :)

Yes.. this little patient's meds were a MESS when I signed her up. She had been sent home with two WMart bags FULL of those NH med cards with the pop-out bubbles.

She tried filling her medplanner with ALL those meds along WITH many OLD OUTDATED ones from prior to hospitalization. She has poor eyesight, and had mixed up all KINDS of meds.. tripled up on heart meds and lasix, doubled up on others..... it was a NIGHTMARE. I spent three hourse there doing that SOC.. was in tears by the time I left.

I shudder to think what would have happened if she had taken the meds as she had set them up. :o

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