Hiding meds from residents. What do you think?

[Marti Ann]

Dear Colleagues,

In the instance where a schizophrenic resident is refusing to take his medications in a nursing home, under what circumstances (if any) can a nurse hide medications in the patient's food, and does it matter if it is an antipsychotic medication vs. antihypertensive medication that's hidden?

Any rules or laws on this.

Thanks for your answers.

[bargainhound, RN]

There must be a doctor's order.

[Angela Mac]

This is a really tough one-

Resident's Rights- He has the right to refuse medical treatment/medications.

I have been this route before.

On one hand- he is not competent of making decisions for himself (schizophrenia) and we need to follow Doctor's orders

On the other hand- it is abuse if we try to trick the patient into taking their meds or hiding them in their food

On the other hand- we are neglectful if the pt. has a psych episode

On the other hand-----oooops ran out of hands

My point---document everything

[CHATSDALE]

this is rough because you are obliged to give the best care to resident (giving him the meds) you are also obliged to respect his right to refuse meds/meals/baths etc once we were putting crushed pilles in one resident food when he found a pill that had not be crushed enough...refused to eat after that because he thought we were trying to poison him....finally convinced hem that all poison had been thrown out...family stopped his cigarettes and we doled them for the amount of food eaten. [w/food crushed THROUGHLY inside] some people say that psych is a piece of cake..i hate them people

[RN4NICU, LPN, LVN]

This falls under state law, so it will vary from state to state. Some states do not require a patient to be a danger to self or others (Ohio is one), as long as the person has been declared by a court to be incompetent to make medical decisions. Other states will not allow a person to be medicated against his/her will unless they are a danger to self or others, and that is also for the court to decide.

This is the prime example of a case where I would not simply go by a doctor's orders. Just because the doc says to do it, doesn't make it legal and an order won't protect you. Usually these rules, whatever they are in your state, apply to all medications and treatment.

[elkpark]

RN4NICU is correct -- the law on medicating without consent varies from state to state, and you need to be familiar with the law in your state (where you are practicing, that is) and FOLLOW IT. A physician's order is not, by itself, enough. Please do not carry out doctor's orders that conflict with the law! I work as a state and federal surveyor/inspector, and it is not uncommon for us to cite hospitals for this exact thing. Also, you could personally end up in court if the patient decided to sue later ...

For instance, in my state, no voluntary patient can ever be medicated against her/his will (outside of an emergency where the person is actively attempting to hurt self or others, that is). If a voluntary patient is refusing meds (on an ongoing basis, that is), they can either be discharged or, if the physician feels that the patient meets the criteria for involuntary commitment to a psychiatric unit, the physician can initiate the commitment process. Patients who have been involuntarily committed can have medication forced on them, but two different physicians have to agree and document in the record that the medication is the only treatment option for the patient, and the patient will continue to deteriorate without the forced medication. (Again, I stress that that is the law in my state only!)

Of course, if the patient has been adjudicated incompetent and has a legal guardian, then the consent is the guardian's to give or withhold (and you do need to have documented consent from the guardian!) Please note that a family member who has been looking after the person, helping with her/his finances, etc., is NOT the same as a court-appointed guardian. You need to see the court order appointing the guardian before you do anything to a patient on someone else's say-so, if the patient is refusing.

Also, in every psych setting I have worked in over the last couple decades, when we did medicate patients against their will, we didn't sneak the meds into their food -- that is highly unprofessional and dishonest (and, as Chatsdale described, creates a whole new set of problems ...). Typically, when someone is having medication forced on them, they are offered the choice of voluntarily taking po meds, or having staff give them an injection (holding the patient down, if necessary). More often than not, once it becomes apparent that this is really going to happen, one way or the other, the patient will go ahead and take the po meds rather than struggle against staff and get a "shot."

Hope this info is helpful. Best wishes.

[leslie :-D]

but also remember that although some of these patients appear to consent to the po, there are those 'pros' that pocket the meds in their cheek while it looks like they're swallowing it for you.

i fondly recall a specific patient i had and this guy was quite adept at outsmarting us.