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Discussion

Informed Refusal for Hypoglycemic

Hello. I work in a group home for behavioral health clients. We have a young female in early 20s who often refuses to tell us her glucose levels and carbs for her sliding scale.  Diabetes is hard for her and she does not like being in the group home so she expresses her independence as much as she can and often its not telling us important info in order to give her insulin. She wears devices that read the insulin levels but we are not allowed access to it (her request). When we ask for her levels or carbs she ate...she screams and swears and slams the door in staff faces. When asked why, she says because she likes to and "because I can" She is on a suspension until our team can help with solutions for better compliance while she can still maintain her rights. Health and safety is priority so we cannot have her in the group home if she is not giving us her levels and info when we need it. She also refuses help when she is hypoglycemic and it appears consistent with self injurous behaviors and ideation.

My question: Can someone suggest ideas of how many times a refusal can be had before it is considered her not trying or "informed Refusal" to where we gave it a shot and tried but she has not stuck with her agreement? I realize factors such as severity of the situation etc... matters and keep in mind it has been over a year with education on what can happen and encouragement from staff so I don't feel its there that we are lacking. She "promised" to be better but we have seen this 5 times before on other meetings and plans. What can be a fair trial idea of her refusing and what level we say....OK we are done? Please don't say company policy and follow it as we go case by case.

 

Thank you for all suggestions.

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    Please don't say company policy and follow it as we go case by case.

    It doesn't have to be a blanket company policy per se, but there absolutely needs to be a care plan on paper for this patient.  Just as you are requesting, someone (or group including the patient if possible) needs to come up with a reasonable response that is appropriate for this patient's situation and stick with it.  
     

    What kind of specific plans/approaches have already been tried?

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    So she has quarterly's that consistently bring up her attitude, treatment of staff, and refusals. However this last  episode which caused the suspension was her refusal for staff to intervene when she was at a 40 blood glucose and 911 was called. Because of that I don't think they have taken her promises of compliance and lack there of to heart. Nursing was not involved prior but is now due to health and safety which is why they are looking for guidelines on what is an acceptable amount of refusals (with respect to severity) before she is deemed to high risk to be in the home. They wanted to not have her back but I'm trying to advocate for her with some guidelines but falling short on what I can have the company look at and go "OK we can try that" 

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    Question I'm honestly not sure the answer of: Can someone be section 12'd for low blood glucose levels and refusing treatment, which is technically causing harm to self? Similarly to suicidal ideation or self harm in a facility setting?

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    I will preface this by saying I am not a lawyer, so this is just advice based on my own work experience, and you would need to consult with a lawyer to know how to navigate the legalities of this issue.

    Is this person her own guardian, or does someone else have guardianship.   If she is her own guardian, then this will be a tricky situation, as she has the right to refuse as long as you can document that she is A and Ox4 and understands the consequences of not allowing treatment for hypoglycemia and glucose monitoring etc.     If it's a situation where her sugar is high or normal and she won't allow access to her numbers, and she is her own person,  then you would likely need to involve a lawyer and figure out if you can even do anything,    Also I think calling 911 when she is hypoglycemic is the correct thing to do from the information you have provided. 

    Unfortunately if she is her own person and understands the risks and benefits, then I think your hands will be tied.    Again, I am not a lawyer and this is not legal advice, I do suggest you reach out to the company's lawyer and figure out the legalities of the situation and assess whether maybe she does need a guardian.  Best of luck. 

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    It makes sense that she would be transferred out of the group home for refusing to share BG values.

    OP what is your role with the facility?

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