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.

[joanna73, BSN, RN]

We have residents that like to help us "chart" and they will come to visit at the station. We sometimes let the people who are looking for a "job" fold cloths. It depends. You try various things, and everyone has their likes/ dislikes, and ways of responding.

[andrewRN]

I guess the problem lies in the fact that I am simply new at the job and not too familiar with the residents. This night, I simply cannot give a resident her glaucoma eye drops. Talking nicely didn't work, nor did distraction, relaxation, reasoning, smiling, or begging. When I asked my orientor to administer it, same thing. However, in the MAR other nurses do and are able to administer it. It boggles me that I can't even at least get it once.

Oh yeah, she has eyelids made of steel!

[Forever Sunshine, ASN, RN]

I guess the problem lies in the fact that I am simply new at the job and not too familiar with the residents. This night, I simply cannot give a resident her glaucoma eye drops. Talking nicely didn't work, nor did distraction, relaxation, reasoning, smiling, or begging. When I asked my orientor to administer it, same thing. However, in the MAR other nurses do and are able to administer it. It boggles me that I can't even at least get it once.

Oh yeah, she has eyelids made of steel!

Ask them their tricks.

This one resident takes bites(when she does take bites).. that are about the size of a grain of salt. I could not get her to take her medicine which i crushed in applesauce for anything when I first started. So I asked the offgoing nurse how she gets that resident to take medicine. "She likes chocolate pudding and she likes the dietary supplement drink too." So I crushed up the pill.. mixed the powder in chocolate pudding and the liquid meds in the dietary supplement drink. Took it like no tomorrow.

[Butterfliesnroses]

I think you need to just relax and get to know the residents. The rest will come!

I transitioned and had no problems getting my residents to take their pills at the 1st LTCF I worked at but I'd also worked there as a CNA 6 years before, so I knew what the residents liked and knew them very well, and they knew me as well!

I just started at a new LTCF and knew some of them from clinicals and knew what some of them liked. So some of them I sometimes have a hard time convincing. I just do my best to get a good rapport with them and get their meds down them. Sometimes I have good luck and other times I don't. So if they refuse after trying to phrase it a few different times and after reapproaching then I waste the meds and write refused. I work nights at my new job and there isn't that many 4AM meds, there shouldn't be IMO!

[joanna73, BSN, RN]

That's very true...you need to know your residents, and each facility is different. Also, no resident is the same either, and there is not one approach that will work for everyone. We have 30 residents, and they are all different. Once they trust you, it will be easier. However, as I've mentioned here, you may have a couple of people where asking in the traditional sense will not work, either. It just depends. But, you will find a routine after a period of time :)

[Forever Sunshine, ASN, RN]

And sometimes it requires being covered in a blend of crushed anti-hypertensives, senna, narcotics, and applesauce to get to know your resident lol

[vampiregirl, BSN, RN]

If the resident is able to verbalize why they don't want to take their pills, try asking them. Some are worried that the pills will get stuck - try having them take a drink first or offerring applesauce with it. Where I work, if we put it in applesauce/pudding or crush it, we must have a doctor's order. I'm willing to put in applesauce once as a nursing measure to see if it helps, then fax the doctor for an order. I don't "hide" the meds. I'm a new nurse and a very by the book person, so I can sympathize. Trust me, it gets quicker as you learn your residents and their preferences. Just concentrate on doing things correctly, the speed will come with time.

[indigonurse]

A nurses responsibility begins when the offer the medication and ends when the resident refuses. I would chart refuse. Another option would be to come back a little bit later and offer it again or to call the MD and ask if the med. can be given at a later time when the res. is awake.

[CapeCodMermaid, RN]

It is also a nurse's responsibility to explain to the resident the potential consequences of not taking the medication. Of course it won't work when the resident is demented, but for the alert, oriented resident who refuses meds, you should document that you explained the potential risks if they don't take the med and then document their response.