Non-Compliant Alzheimer Patient

[SweetLemon]

So I have this patient who I adore that suffers from alzheimer along with some psychiatric illness who is delusional and choosing not to take her BP medication. She is fixated on the fact that her heart is fine and that when we give her the clonidine and enalapril it only increases her BP.... :banghead:last time I took it her systolic was in the 200s which is not unheard of with this patient but not something I am at all comfortable with considering she could stoke out...

So anyone have any tips as far as getting a patient who is non-compliant with BP medication to take it... I am going to advocate to the Doc in the morning to maybe consider a clonidine transdermal patch but I am wondering if anyone had any tips on how to get the patient to take her meds PO??

[mindlor]

Well I am not a nurse yet, but I do have a lot of experience dealing with folks that are delusional.

That said..from my experience, there really is not much chance of a person with a rational mind trying to reason with a person that has an irrational mind.

A patient who still has their rights, has the right to refuse meds and or treatment. If they die, then its on them. ( I assume that proper documentation is of paramount importance here)

It seems the only option is to have a judge take their rights away and have the patients court appointed advocate call the shots...(no pun intended)...

[SuesquatchRN, BSN, RN]

We just crush them and put them into pudding. Get it care-planned.

[mindlor]

I am the first to admit that I am mostly ignorant.

However, could not crushing pills that the patient has stated they don't want, then giving them to the patient on the sly while they still maintained their legal rights have negative legal implications?

Just askin.....

[tuttle13]

I am the first to admit that I am mostly ignorant.

However, could not crushing pills that the patient has stated they don't want, then giving them to the patient on the sly while they still maintained their legal rights have negative legal implications?

Just askin.....

I agree with you about not giving them on the sly. However in a case where the patient has ALZ and really cannot make a clear decision to refuse meds, I would think that permission to "sneak in" the meds would need to be obtained from the family or whoever has power to make health care decisions for the patient. This is just my guess, but I would like to hear a clear answer from a more experienced RN since I am about to work with many ALZ patients.

Sweetlemon - you absolutely need to talk to the doctor, your supervisor, and the family about this as you stated. This patient could be in serious trouble if she continues to refuse her meds, and you do not want to have that on your hands. Protect your license as well as your patient.

[patrick.gines]

contact the physician.

[SweetLemon]

A patient who still has their rights, has the right to refuse meds and or treatment. If they die, then its on them. ( I assume that proper documentation is of paramount importance here)

While I very much appreciate your input as well as everyone who has responded to this thread I have to say I strongly disagree with the above statement. If a patient is delusional and in a place where they may cause themselves harm (including death) it is our jobs as patient advocates to intercede on their behalf. Even if we have to save a patient from themselves. While I do believe a person who is in their right mind and can make medical decisions for themselves needs to have the freedom to be able to refuse medication I don't believe someone who is delusional and requiring psychiatric care falls under the same category.

Doctors have been contacted and they too are struggling on how to manage this patient but we are all going to keep trying until we find something that works.

[SunnyAndrsn]

We just crush them and put them into pudding. Get it care-planned.

Ditto. Have you been talking to the POA for this pt and/or family? Make sure they are well informed about the pt's refusals as well.

Document, document, document!

[kellyc034]

While I very much appreciate your input as well as everyone who has responded to this thread I have to say I strongly disagree with the above statement. If a patient is delusional and in a place where they may cause themselves harm (including death) it is our jobs as patient advocates to intercede on their behalf. Even if we have to save a patient from themselves. While I do believe a person who is in their right mind and can make medical decisions for themselves needs to have the freedom to be able to refuse medication I don't believe someone who is delusional and requiring psychiatric care falls under the same category.

Doctors have been contacted and they too are struggling on how to manage this patient but we are all going to keep trying until we find something that works.

If the patient is delusional, and in a place they could cause themselves harm, I would hope that they have a POAH to make sound medical decisions for them. If they do not, it would be of utmost importance to get social work or case management involved to remedy the situation. It would be up to the POAH to decide what course of action to take IE: Crushing pills in food.

We do need to be advocates for the patient, but we are legally not the ones to make decisions based on our feelings of the situation. As an advocate, getting the POAH or legal 3rd party involved is the only way to CYA. Family can always come back and sue you either way= "You treated ________ and she didn't want it" or "You didn't treat _______ and she was not in her sound mind to make the med decision."

Just my

[SunnyAndrsn]

I would crush them too, but AFTER I talked to the family/POA. I'd also update the MD and make sure there was documentation that the MD was on board with the crushed meds. I do think the clonidine patch would be a good choice for this pt, provided it's put somewhere where the pt. can't pull it off.

We tell one of my residents that we have her vitamins, not her medications. Sometimes just using different language can make the difference. Several of her meds ARE vitamins, and her POA is aware that we do this--she actually recommended it to us for compliance.

Another resident has very advanced dementia with parnoid features, and has recently started refusing her meds on the basis that "you're trying to narc me up." Without her psych meds and UTI prophalysis, she is violent, kicks, bites, hits, and refuses cares. It's absolutely an issue of self harm and safety to staff that she take her medications, so we have an order to crush her meds if she refuses. Her POA (her son, who is also an MD) is well aware of the situation and is on board with the plan.

I agree with you about not giving them on the sly. However in a case where the patient has ALZ and really cannot make a clear decision to refuse meds, I would think that permission to "sneak in" the meds would need to be obtained from the family or whoever has power to make health care decisions for the patient. This is just my guess, but I would like to hear a clear answer from a more experienced RN since I am about to work with many ALZ patients.

Sweetlemon - you absolutely need to talk to the doctor, your supervisor, and the family about this as you stated. This patient could be in serious trouble if she continues to refuse her meds, and you do not want to have that on your hands. Protect your license as well as your patient.

[Coriander, BSN, RN]

I am not a nurse either, however worked for some time with Alzheimer's residents. We would put their medication in their favorite foods... one woman stoutly refused everything, but loved her coffee, so we'd mix the meds in with her coffee in the morning. Sweet was their last taste sense to go, so if you can get the stuff in with chocolate, that was always a winner. We'd have lines of people ready for their "evening treat" when it was really med time! :)

[Karynica, RN]

yep, crush them and put them in the food. The care plan notes this, the doctor agrees and the family knows we do it and agrees that this is the only route to go.