Patients Refusing Care, then self-medicating

  1. How can you handle patients self-medicating? I just read this blog entry.

    A long time ago, I remember being in the hospital for something unrelated and having the attending tell me I was no longer injecting while I was inpatient. She started figuring out my doses by my weight or some such madness..and I flew up over 200 and sat there. They fed me sugar free stuff...all low carb...and aspartame gives me migraines. They didn't have a clue. After a few hours, I declared that I would be handling my diabetes care and that they needed to stay out of it. I had to sign some "against doctor advice" piece of paper, but my BG went back down to 120 as soon as I dictated my basal rates. Patients: don't ever forget that you have the right to deny care!
    Obviously anyone has the right to deny care, but, there's a difference between denying care and downright self medicating while in the hospital.

    I've worn my insulin pump while inpatient in the hospital before, but that was after the hospitalist and nurses were aware I was wearing it, and informed of my insulin rates and such, and agreed that was the best idea.

    Insulin is one thing, would it be different if a patient decided to self medicate with Xanax or Dilaudid while in the hospital?

    But then what recourse do you have from that? Can you take something away from them that they have a prescription for and own and brought from home?
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    About blondy2061h, MSN, RN

    Joined: Jul '08; Posts: 4,266; Likes: 12,946

    15 Comments

  3. by   texastaz
    I am not a nurse however I have worked in ER, I am a CNA part time because I love it. I did work for a company and provided tech support for diabetic pumpers-which was more extensive than just to find out why your pump or BG meter is not working. This situation is common. Most people who are pumpers are in general very educated about their diabetes-in general I will say the stress is equal with all ages. Confusion, stress and so forth is very common with adults and caregivers. A BG of 200 alone is not a ER alarm.

    There are several support sites for diabetics. I would suggest consulting such a site for support and more information.
  4. by   blondy2061h
    Quote from texastaz
    I am not a nurse however I have worked in ER, I am a CNA part time because I love it. I did work for a company and provided tech support for diabetic pumpers-which was more extensive than just to find out why your pump or BG meter is not working. This situation is common. Most people who are pumpers are in general very educated about their diabetes-in general I will say the stress is equal with all ages. Confusion, stress and so forth is very common with adults and caregivers. A BG of 200 alone is not a ER alarm.

    There are several support sites for diabetics. I would suggest consulting such a site for support and more information.
    I'm not talking just about pumpers. My understanding is that pumpers do generally self-medicate regularly in the hospital. I'm applying this concept across the board. Can a patient refuse the care they're offered and advised, to medicate themselves instead, while remaining in the hospital?
  5. by   texastaz
    I may be wrong - but once in ER - you don't bring food and snacks with you. Your outside medications are NOT - part of the program in ER. To do otherwise and to expect to be in ER and expect to get help from people who do want to help you - eventhough Yes I understand most people know what is best for themselves - it is a situation where IF a patient insist on Self-Medicating ------ the priority is to save the person/also for the Medical Staff to enforce in a ethical and non-threating manner reinforce procedure. Hard spot - pass the buck to the doctor to call the shots. I have seen several people go from ER to Psych. I am not paid enough to put or is my heart in it to call the hard line shot with - to judge or can I make the orders for people who are bent on self destruction.
  6. by   cherrybreeze
    I think I know what you are getting at, beyond the insulin thing....I've had several patients over the years decide to take their own pain meds or anxiolytics, say, but sadly in addition to what WE were giving them. In at least one case, it resulted in a code. We try to lock up home meds, but if we don't know the meds are in their belongings, that can be hard to do (we don't search bags/purses generally, until we feel we have good reason to...and that reason generally is, that we feel the patient is self-medicating!). In fact I had a patient last week that was first on a morphine PCA, that was switched to a fentanyl PCA when the morphine "wasn't working." Well, of course, the fentanyl "didn't work" either. She made a comment to the day RN about taking the Percocet that she had in her purse. The nurse told me this in report. Now, the patient had an NG in, and at that point was not going to be getting out of bed by herself, but that didn't, in my book, mean that a) she wouldn't try taking something with the tube being in, it's not like the tube would pull it back out, or b) that she wouldn't have a visitor or a staff member hand her her purse (not telling them why). I made the decision to take the bottle of pills and lock it up, but I made sure she knew I was doing it. I didn't ask IF she had it, I said, "you have some meds in your purse from home, right?" She was up front about the fact that she did. I didn't tell her that I was taking them from her so that she didn't take them, I told her it was our policy to lock up any home meds for safety overall (which it is). She was OK with it (surprisingly so, IMO). I just had a bad feeling about it.....
  7. by   cherrybreeze
    I guess what I am referring to is a bit different, they're not *refusing* what we're doing, they just are doing MORE than what we are......
  8. by   wooh
    Had a patient that when he found out he was going home would give himself a dose of insulin (without telling anyone) so his blood sugar would drop and we'd have to keep him. We finally started making him snack in front of us before we'd check it on d/c day.
  9. by   fiveofpeep
    If they think they know so much that they can self medicate, why'd they come to the ED anyways?!

  10. by   texastaz
    Quote from cherrybreeze
    I think I know what you are getting at, beyond the insulin thing... b) that she wouldn't have a visitor or a staff member hand her her purse (not telling them why). I made the decision to take the bottle of pills and lock it up, but I made sure she knew I was doing it. I didn't ask IF she had it, I said, "you have some meds in your purse from home, right?" She was up front about the fact that she did. I didn't tell her that I was taking them from her so that she didn't take them, I told her it was our policy to lock up any home meds for safety overall (which it is). She was OK with it (surprisingly so, IMO). I just had a bad feeling about it.....
    Great comment - sometimes other than the patient it is also family members we have to beware of. Cherry - you handled this one Great, fantastic example. Thanks
  11. by   cherrybreeze
    Quote from texastaz
    Great comment - sometimes other than the patient it is also family members we have to beware of. Cherry - you handled this one Great, fantastic example. Thanks
    Thank you for saying so, it's always good to have that affirmation. I can so clearly remember one young gal (late 20's, I think?) that was unresponsive, barely had a BP, and it took us forever to figure out that she was taking her home meds on the sly, in addition to all the crap we were giving her. Both pain meds, and benzos, if I recall correctly. That was enough for me to not trust anyone. I would never go to the length of, say, going through someone's purse or anything without their knowledge, but to me, making a statement like this patient made about taking something is enough!
  12. by   texastaz
    Quote from maggiofliore
    If they think they know so much that they can self medicate, why'd they come to the ED anyways?!

    Thanks,

    Because they Love Us, and need us - SOMETIMES -
  13. by   Straydandelion
    There has to be an order "may take home medications" however I plan to medicate my Mom if she has to go to the hospital. IF her Alzheimer's medication is not given within 5 minutes of her last bite of food/or on a full stomach she will have severe diarrhea 5-6 hours later requiring immodium to eventually get it to stop. This time constraint is practically impossible for those with more then a couple of patients. Analgesics/narcotics etc. however IMO shouldn't be allowed as far as self-medication.
  14. by   regularRN
    [FONT="Comic Sans MS"]I know people who titrate their own psych meds - if such a person was admitted to hospital, I think we should respect this because only they know exactly how they feel.

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