How do you deal with residents who only want to take a fraction of a med ordered?

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Especially if the resident is of sound mind? For example a resident has on order for 1 vicodin prn q/4hrs. She would insist that 1 whole one is too much and if she could take 1/2. I try to explain she does not have an order for 1/2 but would be very glad to contact the doctor and let him know of the request. She, of course, declines. "But why can't I just have half?" I say absolutely not.

Now, same scenario different med, less serious: resident has an order for Mom 30 ml but insists she just wants a couple of teaspoons. Again I try to explain what her order is and negotiate: "ok, I'll bring you the whole 30ml and you can take whatever amound you want and I'll chart on it.". Reply: "No, that's too wasteful! I have to pay for that stuff. You're a hard a--, not like the others."

See my point?:)

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Specializes in Acute Care, Rehab, Palliative.

I have had pts ask for what we call a "half lax" 15 mls of MOM.We just pour them that amount and then note on the MAR they had 15. I have seen pts ask for less than the prescribed dose of meds, we just give them what they ask for and try to get the order changed. Pts have the right to refuse a med outright so we allow them to take less.

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You surely don't suggest that I put 3/4 of a vicodin back in the bubble pack?

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Specializes in ICU.

sure, even if she does not have the order to take half the dose, pt has the right to refuse (6th right). perhaps vicodin knocks her out completely. you document " on pt's request" to take 1/2 the dose, for whatever reason she tells you. the doc could change the order when you speak to him.

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Specializes in Acute Care, Rehab, Palliative.
You surely don't suggest that I put 3/4 of a vicodin back in the bubble pack?

Well no. You would have to document a waste I guess.

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Specializes in psych nursing/certified Parish Nurse.

Yes, the responses that you can "waste" it are correct. There is this strange idea in Western medicine that "the doctor knows best" and "we have to do it this way"... when most of the time the patients know exactly what they need and how much (even those "not of sound mind" are often in this category). Taking the time to access the physician may or may not be helpful (it depends on the open-ness of the physician to different modalities, doses, individual variation, etc--there is a wide range of physicians, of course). Nurses are responsible for administering the "correct dosage" and the "correct medication", but most of "to do no harm." Unfortunately the last often is ignored--and the patient ends up in a vulnerable state... we, as medical culture, have gotten to the point of lack of respect for individuality and differing needs.

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Specializes in mental health, military nursing.

I have families and patients that try and pull that with psych meds! I can't count the number of times the patient (or their mother) takes it upon themselves to titrate their own meds - if the doc wanted to prescribe "the smaller half" of a .25 mg dose of Risperdal, he would have. Therapeutic ranges exist for a reason, and low doses of meds can be worse than no meds at all. I think it's a bargaining tool that makes the patient feel more in control, even when it doesn't make any sense.

Not saying that's the case with MoM, but still...:rolleyes:

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We also have those who will look at the assortment of meds on their palm and announce that they'll take the little one, but not the red one, and only one of the green ones...you get the idea. Fortunately, most of the residents are compliant!

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Specializes in LTC, Memory loss, PDN.

I think it's great if the pt. can achieve desired effect on a lesser dose. Get an order for a lower dose or weaker Rx. As for the moment, I'd educate pt. on right to refuse and ask if it would be easier to swallow if broken in half. I'd also educate pt. that refusal of second half is ok, but cannot leave or give later. Without new order, pt. would have to wait about 4 hours for next dose.

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

This is tricky.

Technically we can't make patients take all or some of their med's. If they only take 1 or 1/2 of something, I tell the shift coordinator/clinical nurse, then document it. Let a more senior nurse deal with it.

Making a patient take any drug they don't want to, from what I learned in law, is considered battery. But what annoys the beejesus out of me, is when old people constantly c/o chronic pain, then refuse their med's. It drives me crazy!!

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Biggest problem I had was that the patient didn't want to be 'wasteful' and wanted us to 'save' the remainder of the prescribed dose. Can you imagine doing your narc count and find here and there 1/4 dose of Xanax or 1/3 dose of Vicodin and fractions of this and that?

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

I am not sure why this should be a problem...wanting to take only half of the analgesic dose (which is prn) should be within the rights of the patient. Technically speaking, if the patient wanted to take 1/2 dose every 2 hours to minimize some side effect of the 1 tab Q4hr schedule, the doc should be willing to accommodate that ...it would still be the same dose/day after-all, and if it controls their pain better then...

Talking about risperidone or other classifications of meds is sort of like comparing apples to grapefruit.

Of course you must waste any unused portion of the analgesic...no matter how frugal the patient may be...their "sensibilities" do not trump our safety standards or legal requirements/responsibilities.

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