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!
Specializes in Gerontology, Med surg, Home Health.
My friend who is a nursing home administrator told me: this facility had a unit off all Russian staff and residents.
I was walking down the hall and saw the med nurse pinching the resident's nose shut. I ran into the room and told her to stop immediately. But, the nurse said, in Russia, if patient won't take meds, we pinch nose...they have to open mouth to breathe and then we put the meds in fast.
Certainly not anything we would do in this country.
NG tubes...I've worked in 9 different facilities..never had one in long term care.
Syringe the medicine in? Good way to break teeth or choke someone.
Tummy acid? Tummy???
Antipsychotics can be injected every two weeks for people who won't swallow them. Many meds do come in patch form. Get rid of all but the absolutely needed ones and you'll have less trouble.
I respectfully disagree. If they are severely demented to the point where they have the ability of a toddler to make decisions, and there's a doctor's order for the med, and the family is depending on me to give good care to their loved one, and if the medication is preventing an exacerbation of whatever their dx is, then it is not up to me to just leave a resident's room w my tail between my legs, saying "Oh, well, if he doesn't want his metoprolol and Januvia, I guess that's ok then. I suppose he won't want his coumadin and digoxin later either." It's not my place to decide if meds are important to them or not. However, I TOTALLY agree that 2/3 of the meds could be d/c'ed and the person will be fine. I've seen folks go on hospice and have everything but Ativan and Roxinol d/c'ed and they live for months afterwards, quite fine, thank you very much!
However, I really intended this thread to be lighthearted and entertaining, perhaps helpful to others. Let's not get in a huge debate here, but I'd be very glad to debate the issue in a new thread!
It is actually illegal to covertly administer medications in the US to a patient who has not been deemed mentally incapable of decision making by a court of law. There are many patients/residents who would most likely be deemed incapable by a court, but without that designation and the appointment of a surrogate decision maker, you can't hide meds in food. A Doctor's order for a med does not mean you no longer need consent, either from the patient or their advocate.
There are short term options to deal with a situation until after the case has been reviewed by a court, which in my state means that 2 Physicians must declare the patient incompetent and this must be confirmed by a CMHP within 7 days, a court finding of incompetence must be instituted for long term covert medication administration.
I realize this is a widespread problem but that by no means justifies it, particularly when perpetrated by the very caregivers who are supposed to be the patient's primary advocates. This use to be commonplace in my facility, although we have gotten much better about going through the proper legal steps to take away the right to consent. While it's true there are many patients who are deemed incompetent anyway, you'd be surprised how many patients we as nurses assume are incompetent and who end up being found competent. The main thing we get wrong is that just because refusing a med may cause a deterioration in their health, that alone doesn't justify covert medication administration, as long as the patient is aware of the consequences then they are capable of refusing.
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
Probably no one wants to hear this but...here goes...meet with the family, tell them the issues you are having getting meds in, make sure doctor is involved (he may discontinue some meds or change things around) document it and care plan it. I know we all do what we have to do, but, what happens if you are observed on a med pass and you syringe meds to a resident or you hide it in their food, or you mix it is a liquid and they won't drink it? Could set yourself up for an abuse problem, or discipline by the board. I'm not just talking about a state surveyor seeing you...there are more eyes than just theirs in the world. I have had complaints from family members and others about residents being forced to take medications and medications being given to them without their knowlegde or consent- demented or not! Cover yourself!...don't flame me...just saying....
Ok, this wasn't really all about breaking laws and a huge debate. I'm just asking for interesting ideas. I just thought the mayo was funny to share.
I apologize for being a wet blanket, but I really wasn't trying to just end the discussion, although I guess I was trying to steer it in a direction that was off topic.
This is a topic that deserves far more discussion than it gets and while this may not be the appropriate thread for it, I would agree that another thread would be worthwhile. I included the qualifier that this is illegal "in the US" because the UK Nurses actually took this into their own hands and said it's an issue that happens all the time yet nobody talks about it, so we are going to at least set out some more realistic ground rules and take some steps bring this topic to light, even though nobody involved seems comfortable talking about it. There is a lot of controversy surrounding the decision in the UK, but at least it's getting talked about which is really the only way to come up with the correct answer a problem that ends up putting us as nurses in a bad position with little control over the situation, so please, discuss.
:eek:
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Ms.RN
917 Posts
Sometimes I wish all meds are made in transdermal patches especially seizure medicine.