Odd or creative ways to give meds

[CloudySue]

We all have those tricky folks who, for whatever reason, are a daily challenge to medicate! Please tell us about it! I'll start:

I had a woman who had to be given several pills, plus TWO Occuvites and a calcium (all huge). She was severely demented and sat quietly all day. Would spit pills crushed in applesauce out and then clam up. Her husband clued us in that she always loved mayonnaise on food. So... we mix her pills in that, and lots of it, since she has a TON of powdered pill to take. We also will take that mayo and mix that in her pureed food. Bleh! Recently we had someone from corporate do med cart checks, and was upset to find packets of mayo in there, until we explained that it was as necessary as the bowl of applesauce!

I had another gentleman who a stubborn mule, and profoundly demented. He always refused pills from me. He always seems to take them from the nurse who normally runs the floor, so last time I said sadly, "You always take pills from ______. You're going to hurt my feelings if you don't take them from me too." And it worked!

There was another woman with severe mental illness, stayed in bed all day and would scream and cry if anyone would go near her. (ADL's were a nightmare for CNA's, biting, scratching, etc.) So we'd sneak her liquid valproic acid and Paxil in her orange juice. Soon she was on to us and wouldn't drink it. But for some reason, we started pouring it on her food, like jelly on toast, or even in her breakfast burrito like salsa, and she would eat it every time! When Paxil stopped being made in liquid form, we'd crush the pill, mix it in the valproic acid, and pour.

Then there was the guy who had about 12 pills and just popped and chewed them up like they were M&M's!

[bethann27]

I'm really against adding it to food or drink - for me the benefits of getting the med in the patient doesn't out weight to chances of someone else eating or drinking it.

With that said . . . I have used yogurt lots of times. Their mouths are usually dry and stale & the yogurt is a fresh taste compared to pudding or applesauce. I'll say things like "isn't that wonderful fresh strawberry (or whatever flavor I have) & they usually agree and make Mmmmm sounds. You do loose the benefit of the extra calories you get w/ pudding.

With others who just don't like to take it or are paranoid I try not to use the word medicine. I'll wait until they are doing something they enjoy or are with another person who does take their meds. First I'll say hello to both & smile, then give the other person theirs first @ this point just say "Oh I have yours too" "Would you please hold your water & I'll hold this part". Down the hatch it goes. Guess peer pressure continues up until death.

Most patients w/ dementia or Alz instinctively know when you "break" common rules of communicating ie. saying please, thank you, knocking on their door, asking before doing something or doing something without explaining etc. & will then instinctively refuse to do what you ask. Also, they aren't able to process things quickly so if you are prepared & give a nice simple instructions before they have time to think it through they will usually do it.

Remember to smile :) & know that with some no matter how well you approach them or how many times you try - they still might say no. That's okay too - just deal with it from there. Good Luck. I'm looking forward to hearing something new on this topic!

[VivaLasViejas, ASN, RN]

Well.........for one thing, it really is NOT OK to hide meds in food or drink no matter how demented the resident may be. We may crush meds or give them in liquid form to certain residents because they cannot swallow normally, not to deny them the right to refuse. There's a big difference!

Besides, we totally overmedicate the elderly in this country, and if we were to get rid of 2/3 of their meds I don't think anyone would miss them. Nobody needs a vitamin pill so badly that it must be crushed into powder and 20 minutes of staff time wasted trying to get it into him/her. Same goes for the chemical stew of calcium tablets and other supplements, stool softeners, herbal remedies, APAP, antipsychotics, diuretics, and everything else that either does no good or detracts from their quality of life: doctors prescribe them because it makes them feel like they're doing something, and we fail to question it because we're too busy preparing the next resident's 20 morning meds.

Climbing down off my soapbox now..........

[Forever Sunshine, ASN, RN]

I have one resident who will .. violently refuse.. her meds. Antibiotics have to be given via injection because theres a good chance she might refuse it.

For her PO meds.. I get her around 7pm. I say to her, "I'm going out to get ice cream and I want to get something. What flavor do you want?" She loves chocolate things.. sometimes vanilla. If shes in a bad mood she will say no but I bring her a chocolate ice cream anyway. I come back with her meds crushed(very finely) and mixed in the top third of the ice cream with graham crackers on the side . like spoons. And I dip the graham cracker in the "ice cream" and she loves it. I tell her I used to be a professional chef lol.

Shes the only one we have to trick into taking medicine. We have to do it because if we don't give her the meds she can get very violent and its very unsafe to herself, staff and other residents. I believe this is careplanned that we can do this.

[locolorenzo22, BSN, RN]

regardless, not ok to "hide" or "Trick" people into taking medicine. If they aren't able to take the pills, some other method needs to be addressed. My own general way is to crush in AS or ice cream and give a bite or two that does not have meds in it, then dump it in quickly and give another bite. I have also dumped meds in OJ, dissolved em, and then syringed them....you do what you have to do to get them down, but I always mention that I'm giving them their medication.

[nurse2033, MSN, RN]

Mayo? Yuck! Do you add some Lipitor to it so she doesn't clog up?

[P_RN, ADN, RN]

My MIL wouldn't take her baby asa. So my BIL just left it out. She had a clot and stroked. Hmmmmmm. She always took it for me cause I told her it might keep her from having a stroke.

[indynurse '87]

After crushing and placing in AS/Pudding or other medium, if you have a resident that will take what I call "birdie bites", taking just a small amount off the end of the spoon and just absolutly will not open their mouth, place a small amount of the med mixture on the bottom lip and they will lick it off! It can take a minute or two to get it all in them, but you DO get it in them.

[CrazierThanYou]

I work in assisted living and I have a resident who gets very upset when she sees that you have several pills for her. I try to keep her from seeing what I have. I give them to her one at a time and I tell her what they're for. If she starts getting anxious, I'll just say "It's okay, there are only ____ left and you'll be all done." Works for me every time.

[CaLLaCoDe, BSN, RN]

I learned this trick from an LVN/NEW RN who used to work LTC. Great tip.

When giving meds through an NG, crush them, then place them in warm water or hot water (doesn't matter!) inside the medication cup: helps them to dissolve quickly for administration. Be sure you let them cool or add cool liquid before administering though :)

If you're concerned about this act degrading the strength of the pills, what about the highly destructive hydrochloric acid in the tummy?

[CaLLaCoDe, BSN, RN]

Mayo? Yuck! Do you add some Lipitor to it so she doesn't clog up?

:lol2::lol2::lol2:

[CaLLaCoDe, BSN, RN]

Then there was the guy who had about 12 pills and just popped and chewed them up like they were M&M's!

I've seen this before, drives me nuts! Or what about the person who needs to have a mouthful of water prior to popping those pills in their mouth?! Heaven forbid if I don't think they're going to gag and keel over following this practice!