Hiding meds in food: illegal?

[gilmet]

I'm new here so I hope I am posting in the right place. My adult son who had a brain tumor removed over 10 years ago is currently physically and mentaly disabled. He lived at home with me for 8 years, but considering my age and diminishing health, I could no longer take care of him. I live in a somewhat isolated area, and their are no places for some one like him. He is not elderly, but I was finally able to get him into a nursing home close by. I became his guardian because the damgae to his brain from having the tumor removed, some what mimics alzheimers, he is very stubborn and he does not have the cognitive functioning that is required to make a logical decison. Being his guardian I reguested that they hide his medication in his food. Unfortunately the head nurse on that wing refuses to do that. She claims it is deceitful and illegal. Because their is a danger of blodclots, he is supposed to take coumadin. Now his feet are all swelled up and I fear he may get a bloodclot and die. But still the nurse refuses to put the coumadin in his food. Other then that it is a good nursing home, and their are no other nursing homes in the area. They are telling me that I am requesting they do somthing illegal. Well I feel refusing to do what I requested (for his survival) is illegal. I fear if I get to persistent they will find a way to transferr him out of there. I don't know what to do?

[CareteamRN70]

You could talk to the MD overseeing your son at the facility and request a "crush" order for his regular meds, or "mix with food" order for coumadin (shouldn't be crushed). Unless it is a med that specificly can not be crushed, it can still be mixed with food. Normally this is done for dysphagia where the patient has trouble swallowing pills, but I have seen it to make it easier for patients to get their meds down just because they dont like pills or the taste of the med.

Sometimes a nurse will request the order if a history of not taking meds is noted, sometimes the MD will catch it. Best to discuss it with the MD.

[Esme12, ASN, BSN, RN]

This can be a challenging question....one perhaps answered by a lawyer.

If you are legal guardian........... it places you in the position of authority that you had when he was a baby and unable to make decisions for himself. He has been deemed unable to make decisions for himself and you are his decision maker. Just as when he was a baby and you held him to give him his immunizations "without his permission" being guardian gives you that same decision making position, and as I understand it (and I am NOT a lawyer), have the legal and moral authority to dictate that his meds are crushed and given in food and not offer choices. Just like you can tell a 2 year old you are going to give them a shot but the two year old themselves cannot say no if the parent gives permission.

I suggest you talk with your lawyer and the director of nursing and the MD in charge of the facility to get everyone on the same page. I'll bet that nurses at the nursing home are unaware of the legalities as they probably don't deal with this often in such a remote area and your son having a special set of circumstances. I would also talk to his previous/present PCP to speak with the MD in charge of the facility to help educate the nurses.

I am NOT a lawyer nor do I play one on TV.......I hope this helped. :heartbeat

[tiredbeatupRN]

Does this mean he has not been getting his Coumadin at all? Has he been taking the Coumadin EXACTLY as ordered by the MD? Has the NH contacted your son's MD to report missed doses? Is his Protime being monitored more frequently as a result? If "no" to any of the above, the NH is in the wrong.

What has the NH doing to "fix" this situation?

I'm wondering where they got the idea that administering a med in food is illegal.

[karmyk]

Has the head nurse discussed this with the doctor at all? IMHO if a patient is refusing to take any critical medication, it's the nurse's responsibility to inform the doctor to see if the doctor can write an order for an alternative method of giving the medication or an alternative medication/approach altogether.. I'd discuss it with the doctor if it feels like you're getting nowhere with the nursing staff.

[Fiona59]

Why is this thread even still open? The OP isn't a nurse or a nursing student.

We aren't permitted to give legal or medical advice here?

[Flo., BSN, RN]

It is not that it is illegal to put medication in food. It is that is illegal and unethical to hide medication in food and to trick a patient into taking something that they refused.

This situation is unique because the mother has legal guardianship. I personally would not know what to do in this situation myself, because all during nursing school and in nursing orientation we were taught that the patient has the right to refuse any and all treatments. If this was my patient I would consult the MD and legal department at the hospital.

Any alzheimer's nurses here, what do you do in similar situations?

[NurseLoveJoy88, ASN, RN]

I worked with Alzheimers patients and I know the challenge of getting some of them to take their medications. You should talk to the MD and request an order for meds to be crushed and mixed with food. The nurse should be sure to administer the meds in a small portion with mixed food because if your son does not eat the whole portion then he may not get the full dose.

This is a situation that is not in black and white. Good luck

[FLmomof5]

We have one patient where the order states to crush meds and mix with food. We have to mix it well so that he can't tell it's there. He has dysphagia, but will not take meds crushed in applesauce.

[KareBear0609]

How about we just close this.....

[NurseLoveJoy88, ASN, RN]

It is not that it is illegal to put medication in food. It is that is illegal and unethical to hide medication in food and to trick a patient into taking something that they refused.

This situation is unique because the mother has legal guardianship. I personally would not know what to do in this situation myself, because all during nursing school and in nursing orientation we were taught that the patient has the right to refuse any and all treatments. If this was my patient I would consult the MD and legal department at the hospital.

Any alzheimer's nurses here, what do you do in similar situations?

A patient does has a right to refuse however if the patient if cognitively impaired and has a legal guardian then the patient no longer has a say in his/her treatment. It sounds harsh but this is the only way to ensure the patient is well taken care off.

I once had an alzheimers' patient fall. Based on our assessment it looked as though her hip was broken. We call 911 to have her sent to the ER for eval. and tx. Once the paremedics got there she started to scream " no, I'm not going, no I'm not going" The paramedics documented it as a refusal and attempted to leave her there with a possible broken hip. I stopped them and explained that she is demented and cannot make the choices in her best interest, I had to call the POA ( thankfully she answered) to get her to tell the paramedics it was ok to send mom to the ER. Long story short the pt. did have a broken hip and she died a few days after surgery.

So yes patients have a right to refuse but only when they can cognitively make these decisions. Almost like parental consent in a way.

[CrunchRN, ADN, RN]

Nurselovejoy nailed it.

Request that the physician write an order. That should make the facility staff comfortable that they are not violating his rights.

If he will not eat the apple sauce then it is a much bigger issue because you cannot physically force him to take the medication. Be prepared (as much as you can) to realize that sometimes a med has to be discontinued in this case. A very, very difficult situation for loved ones and professional staff.