Meds in food

Published

I was told by coworkers that if someone won't take their meds you should put it in their food. I thought you weren't allowed to force someone to take meds and that seems like force. I asked if I needed to get special permission from family or something signed, but they said no you just do it. Is this normal in LTC? I was told that I can't keep writting refused on the MAR, that I will get in trouble. Can't I just document it and make sure the DR and family knows.

Up Vote Up Vote ×

I learned the same thing. Do not hide meds in the food. You have to ask the client if he/she is okay with you putting the meds in the food or apple sauce. You also have to tell the client what meds you are giving.

Up Vote Up Vote ×
Specializes in PICU, NICU, L&D, Public Health, Hospice.
I was told by coworkers that if someone won't take their meds you should put it in their food. I thought you weren't allowed to force someone to take meds and that seems like force. I asked if I needed to get special permission from family or something signed, but they said no you just do it. Is this normal in LTC? I was told that I can't keep writting refused on the MAR, that I will get in trouble. Can't I just document it and make sure the DR and family knows.

First, who is questioning your practice and telling you what you may and may not do? Is this your nursing supervisor or a peer? Second, there should be a policy and procedure manual which directs how you handle medications. Third, you are quite correct that you do not make medical decisions for the patient...the patient refuses and you cannot change their mind...so you report to the MD. Then you document exactly that...you know, the who's, what's, where's, etc.

Certainly this is also an ethical issue...I mean, if this is an elderly person, with lots of chronic illness, it is not unreasonable for them to make a rational decision to stop treatment...to allow nature to "take its course". I have had patients who were admitted to hospice for precisely this reason...they stopped all meds and treatment...so, if you think this is "ok" for a patient and it is in keeping with what you understand to be the wishes of the patient and family, you should advocate just that to the physician.

In the younger population, in cases of altered cognition, etc, the ethics become even stickier. Either way...the medical plan of care...which includes what meds when by which route...are the domain of the physician. If the doctor wants you to conceal the medication from the resident/patient in their meal, you should have an order clearly stating such. If the patient has a DPOA they must be notified...this represents a significant change in the plan of care. If you have any discomfort with carrying out that order you should follow your policy which directs your actions in those general situations. Some nurses opt out of some type of activities...not uncommon, for instance, in OB depts where terminations are conducted. So, if you feel that you are compromising your ethics or values to participate in that you should be able to opt out.

Up Vote Up Vote ×

I didn't know a doctor would actually write an order to hide medicine in food. I know giving with applesauce is often done to facilitate swallowing, but hiding the med? New one on me.

Up Vote Up Vote ×

In California it is illegal as in against the law to hide meds in food.

Up Vote Up Vote ×
Specializes in LTC.

For a patient who is A+Ox3 I would never ever do that.

However we do have one dementia(big time) patient with behavior disturbances and insomnia and multiple falls. She will refuse medication if you give it to her in pudding/applesauce.

We have to crush her meds up in ice cream. I let her pick the flavor. She doesn't know her meds are in there but if she doesn't get her "ice cream" she will be very violent, combative, and in danger to herself and others.

Up Vote Up Vote ×

I would be violent if I didn't get my ice cream too.

Up Vote Up Vote ×
Specializes in LTC.
I would be violent if I didn't get my ice cream too.

Me too. Ben and Jerry's Phish food is calling my name. I sit and talk with her while she eats the ice cream so I know shes consuming her medicine. She is content after she gets it.

Up Vote Up Vote ×
Specializes in PICU, NICU, L&D, Public Health, Hospice.

I completely agree...concealing meds in a meal is completely different from putting them in applesauce so they are easier to swallow. This is why I stressed that an MD order is required. And that the DPOA must be notified. And that the nurse may opt out.

This is also why I am wondering who is telling her this...doesn't sound like a nurse to me...

Up Vote Up Vote ×

I believe hiding meds in food in my state is also illegal. If the patient wants to refuse meds, that is a part of their rights. Forcing someone to take meds is against their rights and big no no.

Up Vote Up Vote ×
Specializes in Gerontology, Med surg, Home Health.

You won't get in trouble if the resident refuses meds as long as you document it properly and notify the MD. You can't hide meds in food...it's illegal in most states and unethical as well. Even demented people have the right to refuse medications. If the person has a guardian, the guardian can state that the resident can have the meds in food, but it's important that all this is documented in the record.

We have a resident with severe schizophrenia. He also has severe basal cell CA on his face. He refuses to bathe. He has a Roger's Guardianship which allows us to give him meds but we are forced to go to court and have a judge decide whether or not we can force him to bathe. It's not going to be easy either way.

Up Vote Up Vote ×
First, who is questioning your practice and telling you what you may and may not do? Is this your nursing supervisor or a peer? .

It is my fellow floor nurses telling me this is what they do.

Up Vote Up Vote ×
+ Join the Discussion