Involuntary Patients Refusal of Medication - Canada

[verivici]

Hi! I'm working on a case study question right now and I have not been able to find the answer anywhere! The question is: An involuntary patient under your care becomes agitated and refuses to take his medications because he believes the medical staff are "trying to poison him". How would you, as a competent nurse, respond in this situation? I have been looking at my provincial mental health act, as well CMHA ect and have not been able to find an answer for this. Common sense tells me that you cannot force a patient to take a medication they are refusing, however since the patient in the case study is involuntary I'm not sure how (or if) that changes their right to refusal of treatment.

[Meriwhen, ASN, BSN, MSN, RN]

This is the US psych nursing POV.

The fact that a patient is involuntary doesn't necessarily mean he is forced to take his medication. He has as much of a right to refuse a medication as the next patient.

However, we can force a patient to take a medication if the medication was court-ordered. This is usually done if the patient's psychosis is severe enough that they are a high risk of danger to themselves or others. It may be written to offer the patient a choice between taking the ordered med in PO and IM forms, with the IM being used if the patient refuses PO. I've seen this one done with Haldol a lot.

Or it may be an entirely different med that is court ordered, such as: "Zyprexa 10mg IM only if patient refuses medications." If the patient takes the rest of his meds the Zyprexa IM isn't given; if he refuses his meds he gets the shot.

Our doctors are concerned with refusal only as far as psych meds go; if a patient takes all their psych meds but refuses their omeprazole, they're certainly not going to get a shot of Zyprexa for that.

[loriangel14, RN]

I did deal with this fairly recently and the involuntary patient refused meds.We just documented refusal and left it at that.We can't force them but then again these were only mD ordered, not court ordered.

[Esme12, ASN, BSN, RN]

I don't know about Canada but it's not whether they are voluntary or not it's whether they have been found competent to dictate their own care and under certain provisions they can be medicated against their will if they are "temporarily incompetent" and a danger to themselves or others and need to be physically as well as chemically restrained. PM me if you want US links. I'll do a quick check for Canadian links

This may give you a lead

http://en.wikipedia.org/wiki/Involuntary_commitment