Non compliance?

Katillac, RN · Apr 13, 2019

On 5/19/2018 at 1:33 PM, Glycerine82 said:
I'm just curious what you all think...
I have a colleague who insists that when a patient is noncompliant regarding their diet, (diabetic CHF etc.) even when we document and alert the provider they are not adhearing to it, that we can ultimately be held liable?
Im in a sub acute rehab setting.
I feel like the patients have the right to do what they want and as long as we educate and document, the rest is out of our hands.
My colleague says the reason they have a diet ordered is to ensure they adhere to it. I just don't see how if I do everything in my power to keep the patient in compliance but they still choose to eat whatever they want, I've done all I can do.
What at do y'all think? What can I do differently?

I think I'm glad I wake up being me and not your colleague. I can't imagine how much stress he or she must be under thinking they are responsible for delivering outcomes over which they have zero control. Your colleague fails to understand that the only real discipline is self discipline anyway, and that all her or his efforts to play diet police will come to nothing as soon as the patient is out of sight.

There was a thread a bit ago about something similar, implying patient education is out, and nurses are now obliged to do successful health coaching. Though I'm not sure if it's what your colleague was referring to, the whole health coaching thing is yet another way the third party payers are trying to pressure the nursing staff to deliver better (read cheaper for the insurance companies) outcomes. Every time nurses silently accept a new obligation pushed on them they are complicit in their own undoing. Just saying.

ComeTogether, LPN · Apr 14, 2019

With her its more like control. She seems to choose to focus on things that really aren't important next to providing patient care and helping our unit run smoothly. Diet non-compliance (especially with diabetics) and whether or not to give PRN meds together are her favorite. Oh and choosing to hold cardiac meds with a BP taken on a wrist when there aren't any parameters and the patients aren't symptomatic. It's frustrating.

allnurses Guide · Apr 14, 2019

1 minute ago, Glycerine82 said:
With her its more like control. She seems to choose to focus on things that really aren't important next to providing patient care and helping our unit run smoothly. Diet non-compliance (especially with diabetics) and whether or not to give PRN meds together are her favorite. Oh and choosing to hold cardiac meds with a BP taken on a wrist when there aren't any parameters and the patients aren't symptomatic. It's frustrating.

Wrist BP cuffs are wildly inaccurate and all BP meds should have parameters!

kbrn2002, ADN, RN · Apr 15, 2019

On 4/14/2019 at 9:08 AM, hppygr8ful said:
Wrist BP cuffs are wildly inaccurate and all BP meds should have parameters!

I will agree that wrist BP monitors are not known for their accuracy but I have to disagree that all BP meds should have parameters. Depends on the setting and the history of the patient. I work in a SNF and of my 24 residents 22 of them are on some kind of BP med and have been on that med for years. If I had to do a blood pressure on every resident with every med administration my med pass would take forever and a day to finish. Now if it's a new resident, a new med or a change in dose of a current med we do those BP checks for a time, usually a week but sometimes two. As long as the blood pressures remain in a acceptable range and are stable we discontinue them. Out of my 24 residents there is only one that has orders for a daily BP and she is a CHF patient with a history of being unstable so the heart clinic did order a daily check, but even that is only daily and not with every med administration.

Forest2 · Apr 25, 2019

I think you just need to make sure you document what you taught them and explained to them the rationale for the diet and what the consequences of not following doctors orders can be, then you document the response to the education. I evaluate their understanding and comprehension by having them repeat and teach back. Then as far as I know you are free and clear and they can do whatever they want. After that I don't consider it my responsibility.

Forest2 · Apr 25, 2019

On 4/14/2019 at 10:08 AM, hppygr8ful said:
Wrist BP cuffs are wildly inaccurate and all BP meds should have parameters!

I have found they are more accurate than they used to be, I have compared several to manual blood pressures, some are bad and some are good. Not all B/P meds need parameters. It depends on the individual circumstances and the setting.

ComeTogether, LPN · May 3, 2019

On 4/25/2019 at 4:58 PM, Forest2 said:
I have found they are more accurate than they used to be, I have compared several to manual blood pressures, some are bad and some are good. Not all B/P meds need parameters. It depends on the individual circumstances and the setting.

This is true. I have one that I paid good money for where a light turns blue when its in the correct position. I've tested it numerous times and its always within 4mmhg. That being said I trust my ears better than anything, although its helpful for some of my little old folks with tiny, frail arms.

Tiffc88, RN · May 9, 2019

I know we use to have a patient sign a document refusing their diets. But you just need to make sure you're always documenting. You can't force any patient to eat or do shower or to do anything.

We can try and persuade and educate the patients letting them know benefits and risks but never force. I think your colleague needs to look at patient rights, which should be hanging up in your facility or in a book you can access.

kp2016 · May 14, 2019

I think your colleague has some control issues. I recently had a young adult patient with Type 1 diabetes. The patient declined a diabetic diet and said they would like to make their own choices. They pointed out that regardless of what they ate they would have to take insulin so why shouldn't they be allowed to look at a menu and make choices like everyone else. I have to say I really learnt something from this patient about what it feels like to have a chronic lifelong medical condition and how it feels to have other people micromanage your life.

To be clear this patient made very appropriate diet choices and was very compliant with the principles of managing their diabetes. They just wanted autonomy and to be treated as an adult. I realize your post is about non compliant patients but sometimes we need to think about the fact that while we have a responsibility to educate our patient they have the right to make their own choices, even if the choice isn't the "best choice medically"

ComeTogether, LPN · May 15, 2019

Thanks all. I've since learned this nurse absolutely focuses on the wrong things and I have a suspicion its because she never learned how to prioritize and likes to be "the boss". Its sad, because I truly feel as if I am my patients advocate. I am there to explain the risks, the outcome, the rationale behind the diet, etc. but as long as they have all the information they are free to make their own choice. To me its a no-brainer.

I'm still sort of new and when I come across strong personalities it can make me briefly question my own judgement. It's something I'm working on.