No, you can't do that!

[LoveMyRNlife]

I am just curious how other facilities handle patients and their family members that refuse most of the care while in the hospital. I am referring to declining the use of the gait belt, refusing IV fluids, refusing vitals, refusing lab draws, but demanding specific medications. I am guessing the answers may be different for nonprofit and for profit hospitals so please share that in your answer as well.

[cleback]

I assess to see if they know what they're refusing.

I may tell them it's facility policy to do it.

If they still refuse, I document it. If it's a big safety issue, I let the doc and/or manager know.

Nonprofit facilities. Not sure why that would make a difference.

[JKL33]

Listen/understand their rationale, educate/make sure they have accurate information upon which to base decisions, look for appropriate compromises, inform attending as appropriate, involve other services as appropriate (social work), don't violate their rights. These are the basic principles regardless what type of system.

[LoveMyRNlife]

The reason I asked what type of facility is that hospitals in my area will discharge patients much quicker than the nonprofit hospitals when this type of situation arises.

A little more background, the patient had dementia and the family member was calling the shots. The family member was educated on the reason for the gait belt, the reason we couldn't keep giving haldol all night long, why telemetry was so important, etc. all diagnostics came back negative, pt was admitted for AMS" and the family member wanted meds pushed until the patient wasn't agitated but not "snowed". Education was attempted by multiple people from the bedside nurse, the charge nurse, the nursing supervisors, and two physicians. She would simply talk louder and louder, over whoever was speaking to her, demanding haldol and for us not to touch him.

[Aunt Slappy]

Give them some AMA paperwork and tell them if they're going to refuse all appropriate interventions for their condition, they may as well go home.

That's my fever dream response, because I know no place would actually let you do that. Too bad though.

[Daisy4RN]

Give them the appropriate info/education, notify MD, document refusal even after education, done.

We did offer AMA when appropriate and had patients who did leave AMA. I don't see anything wrong with that. Their choice.

[hppygr8ful, ASN, RN, EMT-I]

"Patient/caregiver refused ordered treatment. Education provided on the benefits of treatment and risk's of refusing ordered treatment including discomfort, permanent disability or death and all parties present verbalized understanding. Physician informed."

Hppy

[JKL33]

She would simply talk louder and louder, over whoever was speaking to her, demanding haldol and for us not to touch him.

Legal consult. As in, looking into whether or not this person is an appropriate decision-maker.

If the person appears incapable of or unwilling to use information to make decisions then their ability to act as a decision-maker comes into question.

Generally-speaking a parade of multiple different staff members who say the same thing/have the same goals doesn't change this scenario. If a dedicated, genuine attempt at listening and discussing this family member's concerns and rationales changes absolutely nothing and the person remains unwilling to engage in discussion or hear information which would be beneficial for decision-making then a formal care conference/ethics consult and inquiry into decision-making ability is in order.

[LovingLife123]

I talk extensively with the patient. If they still refuse, I call the physician. They will usually come and discharge them.

I had one septic guy who had awful wounds on his legs from his diabetes. He was refusing care from the wound team. We had a 15 minute conversation. He then allowed wound care to treat all his infected wounds.

A family member refusing care for a patient? I don't know about that. I'd probably go higher up on the ladder. Family members don't get to call all the shots like many think they do.

[LoveMyRNlife]

Unfortunately in this situation, speaking with the patient would not help due to his advanced dementia. This poor patient was a huge fall risk and the family member was demanding he be walked everyday for an hour and a half without the gaitbelt. Multiple people tried discussing his plan of care with this person but each time would be met with yelling and interruptions. It was impossible to finish a sentence once she heard something she didn't want to hear. Her reactions were crazy over the top. The patient actually punched the family member. When a SOMA bed was discussed to keep staff and the patient safe, the family member said " I am sick and tired of hearing about staff safety, that is why I am here!"

It was all documented by multiple people across several shifts but we all felt sorry for the patient because any attempts at helping were met with roadblocks by this family member. Just a very frustrating situation.

[LoveMyRNlife]

"Patient/caregiver refused ordered treatment. Education provided on the benefits of treatment and risk's of refusing ordered treatment including discomfort, permanent disability or death and all parties present verbalized understanding. Physician informed."

Hppy

I agree with this Hppy but one of our biggest concerns was staff safety on top of trying to help the patient. The family member never left his room and all of the yelling only agitated the patient more. It was a disaster waiting to happen.

[LoveMyRNlife]

Give them the appropriate info/education, notify MD, document refusal even after education, done.

We did offer AMA when appropriate and had patients who did leave AMA. I don't see anything wrong with that. Their choice.

This patient would not be safe to leave AMA. If they are alert and oriented and they refuse treatment, that is their right. Unfortunately the patient was suffering because of the family member. Thankfully the patient was discharged to a long term care facility where hopefully they can get the help they deserve.