How far do you force meds?

[andrewRN]

I am a newly graduated and licensed nurse. I started working in a skilled nursing facility.

As I recently learned, med pass for 34 residents can be quite a task. With my calculations, I must not spend no more than 2 minutes and 40 seconds per resident to make it to giving report for the day shift nurses. That time includes accessing double locked narcotics boxes, crushing pills, drawing insulin, etc.

If a patient insists on sleeping, or simply does not want the medication, do I simply write refuse? If that is what I am suppose to do, there would be a lot of "refuse" on the MAR. I don't think the charge nurse would be happy about that. Then again, I can't use force to give eye drops. In addition, the facility is a "no restraints" facility and only uses alarms.

What am I suppose to do?

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.

[lilaclover]

Do the Residents that are refusing all the time need these meds so early? Or are they just scheduled that early to make things easier on Day shift? Maybe they could be scheduled a little later when the pt. is up and about...

[joanna73, BSN, RN]

First off, if I know the resident is going to get aggressive just from the use of the word "medications", I don't say I have medication, and I hide the crushed pills in apple sauce. If they are cognizant and still refuse, I will inquire as to why? If there is a refusal, it is documented and shared with the team.

[egglady, LPN]

I have a resident that will refuse, everytime, when I say "here is your medicine" BUT- that same resident WILL take them when I say "here are your pills". You have to really get creative sometimes with the LTC population.

[CapeCodMermaid, RN]

People have a right to refuse medication. If they refuse explain why they need it. If they still refuse, document it. I call the doc if they refuse 3 x and we discuss the whole medication list to see what we can get rid of so they have less resistance. You can't hide meds in applesauce or ice cream or anything. And, yes. If I have to pass meds, I still go by the book.

[andrewRN]

Thanks for the input everyone. Thanks systoly for that charting advice also. I do take the extra effort to not just simply walk away and write "refused".

Everyone's replies are all helpful!

[joanna73, BSN, RN]

When I am referring to hiding meds in applesauce or pudding this is for the residents who are cognitively impaired (ie dementia). Certainly, people have a right to refuse. However, some people are not aware of what it is they are refusing, they will always refuse everything (including other aspects of their care) and, they would never take any of their meds. We probably have at least 4 residents to which this situation applies.

[Forever Sunshine, ASN, RN]

When we put it in pudding/applesauce its because of aspiration precautions. I still tell them its their medicine in pudding.

[joanna73, BSN, RN]

Yes we do that also, and for sure, I will explain to those people that their pills are in the pudding or applesauce. But for the few we have that are completely unaware of everything, we don't. Its one thing to be able to give informed consent or refuse when they understand and are capable of making a decision. But for the 3 or 4 we have who do not know day from night, and are overly aggressive, explaining that their pills are in applesauce is futile.

[CloudySue]

Ever think of ASKING them if you can give them their pills instead of TELLING them they're going to take them? I always phrased it, "Hi, Mrs. ___________. Can I give you your pills please?" The CNA's would laugh at me, "Listen to her, she's so nice and polite." Well, some very demented residents responded well to that. "Please" is a magic word.

[Forever Sunshine, ASN, RN]

Yes we do that also, and for sure, I will explain to those people that their pills are in the pudding or applesauce. But for the few we have that are completely unaware of everything, we don't. Its one thing to be able to give informed consent or refuse when they understand and are capable of making a decision. But for the 3 or 4 we have who do not know day from night, and are overly aggressive, explaining that their pills are in applesauce is futile.

...like when its 4am and that resident is still up, wide awake, sitting with me behind the desk(because there's no where else safe for her to go) and I have to almost put myself on top of them to keep them from getting up.

Resident- "Ok Michelle I'm going to get a job now. I can't sit here all night." *Gets up*

Me- "Sit down.. nobody is hiring right now.. they might be at 7am, you can go look for a job then. "

[joanna73, BSN, RN]

Yes, we do ask, and we are polite :) however, everyone responds differently. For the 3-4 people I am thinking about in particular, we all still say "good morning, mr/ miss x...how are you today? We have something for you.." It depends on the residents, the level of dementia, etc....

[Forever Sunshine, ASN, RN]

Yes, we do ask, and we are polite :) however, everyone responds differently. For the 3-4 people I am thinking about in particular, we all still say "good morning, mr/ miss x...how are you today? We have something for you.." It depends on the residents, the level of dementia, etc....

I've tried that with her, "Oh get the hell out of here michelle..i'm going to sock you in the face..listen michelle i will take my medicine when i want to take my medicine." So she takes the little plastic cup.. wraps it up in her dinner napkin(used) and puts it in her pocket.

I'm like "uhhhh this is going to be a very long night."