How far do you force meds?

KarmaWiseRaven · Feb 22, 2011

Andrew,

You have no right to force anyone to take Meds. If your force a person you can and will be turned in. If your having problems giving Meds find another nurse to help you. Someone who knows the residents.

Remember your still new there and your residents don't have your trust yet. Seek help from your LPN/LVN's, Charge, ADON, DON, Start opening your mouth so nothing can come back at you like you said a bunch of refuses does not look good on a MAR.

I'm sure as you get to know the people and they get to know you it will become eaiser for you and them to give meds but for right now shadow someone if you can. Best make friends with the residents as well or you will be left in the cold. LTC's it's more then just a job and a lot of new grads don't get that. It's their home your just a guest and i understand the clock is ticking but you can't go by a clock or the rules for that matter understand. Now is the time you ( Wake UP) and chill out on the rules. Your dealing with people who have been on this earth a lot longer then you have been alive. I hope this helps and good luck I'm sure you will be fine.. These are my thoughts use them as you wish

ann4997 · Feb 22, 2011

I too am a new grad and recently worked in a snf with about 32 patients on my 11p-7a shift. I didn't get much of an orientation and every night I worked was a race against time. I didn't have too many midnight meds or treatments but my 6a medpass was outrageous! We all know that we have that hour window before and after the scheduled med, well I had to stretch it a bit and started my medpass at 4:30 and usually finished by 6:30 so I had time to make any additional comments in the charts (depending on my wing -- all 32 patients needed to be charted on -- paper charting and electronic charting), make sure my 24hour reports were complete for the oncoming shift, update any changes in vitals, completed I&Os etc. Like you, I had a lot of finger sticks and about half would need coverage. I also had a few gtube patients (by gravity) so that took extra time. I hated waking people up, but I did it (waking up sick people to give them a prilosec just fries my bacon!) and talked to each one: "Good Morning Miss/Mr. X it's Ann your nurse; how are you this morning? I have your pills for you, and some nice juice; let me raise your bed up a bit so I can help you take them..." It took extra time, but I felt that it was easier being pleasant them, they tended to be more cooperative. I had a few patients that always refused their meds and some that did periodically and I would document it as such and would pass it along on report. I would hope that in time that the powers that be would see the pattern and make a change (just slip it to the 9a medpass).

I don't know if this helped or not, but don't give up, it gets easier as you get used to the pace and the patients.

Good Luck!

Forever Sunshine, ASN, RN · Feb 22, 2011

I'm going to admit I don't do some things by the book. Not because I'm free from a nursing instructor/preceptors reign. but because I see its how we have to do it to get things done.

I start at 4:15. If I'm feeling tired that night.. 4am. Because I don't know about you.. but on 11-7 I liked to be out of there by 7:15am.

On nights when things aren't skies and sunshine.. you are going to have to "close the book".. but never ever ever prepour (I did it once.. I prefer just popping them then and there)

When a confused resident refuses.. I tell them its their medication and the doctor wants them to take it. Sometimes this works. When it doesn't I take it a step further and tell them its for their blood pressure(it is). If they still don't take it for me.. just mark refused and move on..

TheCommuter, BSN, RN · Feb 22, 2011

Some nurses, mostly LPNs, (I don't mean to give LPN's a bad name) simply puts the meds in the slightly confused residents mouths and ask them to swallow. Some nurses simply say "I have a treat for you." I am a new nurse and I do go by the book. I wake the resident up, tell them I have medications for them, and convince them that they need the med. Sometimes it works, sometimes it doesn't. Some would say yes, but shut their mouths tightly. Some would just stare at me. ....oh and the clock it ticking.

After having worked in nursing homes for more than five years, I can see why nurses are hesitant to document a refusal. Instead, they find creative ways to get confused residents to take their meds.

First of all, I must ask a question. Are you really doing things by the book? If you document a refusal, the by-the-book way to proceed is to notify the doctor and family. Are you taking these time-consuming actions after each and every refusal that you document? Do you see why experienced LPNs would rather devise creative ways to get the demented resident to swallow the pill? If a state surveyor looks at all of these documented refusals, they are going to want to know if you made the physician and responsible party aware. They might also want a plan of care created if the refusals are an ongoing issue.

Also, although the demented resident has the right to refuse, they really don't have the mental capacity to refuse, which is why you would notify the physician and family after each refusal and document that you made these notifications.

andrewRN · Feb 22, 2011

Thanks everyone. At least I know it isn't just me. Like you all have said, unfortunately only time can make me know the residents and their preferences well enough.

NurseLoveJoy88, ASN, RN · Feb 22, 2011

I'm a LPN in LTC and I don't force anything meds included on any resident. Instead of me just documenting refusal I use critical thinking skills to help me aid in getting the resident to take the meds. Sometimes it works sometimes it doesn't. For example one resident thinks the med is poisons so we got psych involved and as a team we decided that it may help if we show the resident the bubble pack with all the labeling then that will help her to realize the med is not poison and she will take it. Well that worked. Sometimes instead of mixing the crushed med in applesauce I'll find pudding or icecream. There are times when I have to come back and ask again. In LTC every day is different. Nurses must be a able to think outside the box and keep trying things until something works.

NurseLoveJoy88, ASN, RN · Feb 22, 2011

Oh and so far as doing things by the book..... enough said. Good luck with that one.

merlee · Feb 22, 2011

Why are there so many early AM meds?? Do ALL of the meds need to be given on an empty stomach at least 1 hour before breakfast? And if you are giving coverage for their FBS, when is breakfast? More than 30 minutes is too long.

Ask these questions - put a note in the chart, or ask the docs. And if I am sleeping LET ME SLEEP. Thanks!!!

TheCommuter, BSN, RN · Feb 22, 2011

Nurses must be a able to think outside the box and keep trying things until something works.

Thinking outside the box and trying new things would also fall under the realm of care-planning. Whether we realize it or not, we are always mentally planning how to care for the residents.

systoly · Feb 22, 2011

Documenting "Refused" is a red flag, because of the legal ramifications. Furthermore it is subjective, not objective. If I read refused, I immediately wonder what did the nurse do and I look for further documentation. I prefer to read, "repeatedly clamps mouth", "repeatedly turns head to other side", etc. If you know a certain pt. responds unfavorably to Rx admin, try them at the beginning of your med pass. That way you can make another attempt at the end of the med pass. I know you were taught to go by the book. The question is who's book. The fact that your school taught you to document "refused" is an indication that this may not be the best book on the market. It takes a little time to transition from school teachings to real world application. Give yourself credit for spending time and energy on the pursuit of doing the right thing.

nursynurseRN · Feb 22, 2011

When someone refuses... I just chart it. I never force it. I explain why its important and if they still refuse I chart it. What can you do? They have rights too.