Please be gentle maybe I am wrong in assuming this is abuse. I am currently working at a SNF/Rehab. This is my first nursing job as an LPN. I have a patient who has dementia and has recently starting mental declining according to other nurses. I haven't been the nurse in 1 month for them. I came in on sunday and was informed they due to have IM Geodon Q4H. When i got report the nurse said they had been refusing the med.When I went in to the room and offered the med, I tried to convincing but patient stated "I have the right to refuse, i don't want those shots"This patient recognized me, had conversation with me. Some confusion was evident, but this would be baseline for them.I documented as refusal. Well supervisor came to me and said they received a text from the administrator (no medical background) stating this patient was "not allowed to refuse" and I HAD TO GIVE IT. I told the nurse that this patient has the right to refuse, they are not a harm to themselves or others and I would not be holding them down and forcing them this is not a psych facility.To which response I got "To bad, its a med error if you don't give it, and you can hold them down and give it"I refused so the supervisor took my keys from me and administered the med while the patient yelled and stated "this is my right to refuse, this is illegal"Please tell me I wasn't wrong in refusing to give this med. I was absolutely devastated that a fellow nurse would not advocate for this patient when they were doing NOTHING. They got the med and were so sedated they wouldn't even eat or wake up.Is this not considered a restraint? Abuse? What do I do?
heron, ASN, RN 3,649 Posts Specializes in Hospice. Has 51 years experience. Jun 16, 2015 We can't give legal advice on this site. I'd suggest contacting your company's risk manager as well as investigating your state's regulations on forced medication. There's not enough information given in the OP to know whether this is abuse or not. Forced medication is legal in some fairly extreme circumstances when the resident is a danger to himself or others. Regulations and procedures around this vary from state to state. Forced medication with a drug like geodon is essentially a chemical restraint. An administrator or nursing supervisor doesn't get to say "just do it" with no other documentation and, sometimes, legal proceedingsAt the very least, a call to the state agency that licenses your facility and/or the state ombudsman might be in order.
bugya90, ASN, BSN, LVN, RN 565 Posts Specializes in Ambulatory Care-Family Medicine. Has 12 years experience. Jun 16, 2015 We can't give legal advise but patients do have the right to refuse if they are mentally competent to do so. I would contact risk management and your state reporting agency as well. Also I'd look for a new job as soon as possible.
JustBeachyNurse, LPN 1 Article; 13,952 Posts Specializes in Complex pedi to LTC/SA & now a manager. Has 13 years experience. Jun 16, 2015 Call the state ombudsman. The number should be included in the posted patient rights. If you have a personal malpractice policy contact your carrier for advice
Dogen 897 Posts Specializes in Behavioral Health. Has 1 years experience. Jun 16, 2015 You may be legally required to report this even if you merely suspect that it's abuse, in the same way that you report suspected child abuse. Call someone with the authority to advise you (as recommended by everyone else). The board of nursing, state ombudsman, department of health... whoever oversees patient safety in your state.In my facility even floridly psychotic patients can refuse medications unless we have two physicians assess them and agree, in writing, that the patient is a risk of harm to themselves or others. So, as written,​ this wouldn't be kosher in my hospital.
allnurses Guide hppygr8ful, ASN, RN, EMT-I 4 Articles; 4,721 Posts Specializes in Psych, Addictions, SOL (Student of Life). Has 21 years experience. Jun 16, 2015 We can't give legal advice on this site. I'd suggest contacting your company's risk manager as well as investigating your state's regulations on forced medication. There's not enough information given in the OP to know whether this is abuse or not. Forced medication is legal in some fairly extreme circumstances when the resident is a danger to himself or others. Regulations and procedures around this vary from state to state. Forced medication with a drug like geodon is essentially a chemical restraint. An administrator or nursing supervisor doesn't get to say "just do it" with no other documentation and, sometimes, legal proceedingsAt the very least, a call to the state agency that licenses your facility and/or the state ombudsman might be in order.What she said unless Justbeachy is a man then what he said.As a former psych nurse in California - There has to be la legal proceding with a judge, (usually administrative law judge) a hopsital representative and a patient advocate to determine if a patient can be medicated against their will. There will be paperwork in the chart if this has occurred. In some states POA's can make that decision as well. I would call the state ombudsman to find out if this was legal. Either way I hope you charted that Pt refused med and it was given by supervisor. Always CYAPS Geodon is most effective when give orally with a light snack.Hppy
Pangea Reunited, ASN, RN 1,547 Posts Has 6 years experience. Jun 16, 2015 It could be, but I'd have to hear the other side of the story before deciding.
KMarieD 12 Posts Jun 16, 2015 I'm sorry I didn't realize this was considered asking legal advice. Thanks for the advice. I'm researching my avenues right now.
caliotter3 38,333 Posts Jun 16, 2015 After all of this reporting that you may be doing, I wouldn't want to remain working at this facility if I were you. Just to say, that a version of what you describe is not necessarily rare in LTC facilities. Most nurses either participate, or turn a blind eye, to what goes on. Just one reason why it is difficult to work in LTC.
KMarieD 12 Posts Jun 16, 2015 I documented a lot about the situation! That it was given by supervisor and that they refused me and that thet knew who I was and presenting no psychosis, or danger to themselves or others was evident. I used to work in a psych facility as a tech. There was a lot that went into 'forcing' meds. Not just an administrator said so.
KMarieD 12 Posts Jun 16, 2015 I've actually accepted a position at an ENT office today thankfully ....Tired of being the only one who 'cares' at the ltc.
Pangea Reunited, ASN, RN 1,547 Posts Has 6 years experience. Jun 16, 2015 Please make sure that you have a very clear understanding of the situation before acting. Abuse should be reported, but as a new grad, things can look very different than they actually are. What was the patient's reason for refusing? What behavior was the patient engaged in that got the medication ordered? If family is involved, what is the family's stance? In what ways is the patient confused? Reporting will not make things easy on you, although it's worth it if there's a legitimate problem.
