"Gray areas" in med pass scariest

txspadequeenRN, BSN, RN · Oct 24, 2005

What medication is it and what is the patients reasoning for wanting only part of the medication? This drives me crazy when patients do this to me!!!!

What do you do when a resident insists on getting a fraction of his or her pill? I delegated the task to the nurse because I didn't feel comfortable giving an amount that wasn't indicated on the MAR. Believe me they had tried and tried to fax the doctor to change dosage to accommodate resident's wishes but for some weird reason he is either reluctant to change it or too busy. In the meantime we're put in an awkward spot.

GLORIAmunchkin72 · Oct 24, 2005

I don't want to give too many details but let's just say that it was a psych med and one tiny little pill had to be cut in half, and the pill wasn't even scored. It could have easily broken in even tinier little pieces. Nurse's response: "What the resident ask, you give it".

What medication is it and what is the patients reasoning for wanting only part of the medication? This drives me crazy when patients do this to me!!!!

jetsetter · Oct 24, 2005

The last time I checked a pt has the right to refuse any med/tx they don't want.

I do understand your delimena. I would just chart exactly what happened and exactly what the pt took.

QuilterLPN · Oct 24, 2005

Depends on what the med is, IMO. If they only want half of that pain pill, fine. I'll chart that. A psych med may be a different story. What are their symptoms? Do they really need all of it? Are they taking it to relieve the extrapyramidal symptoms of other pysch meds they're taking? If you're not sure, then get somebody to help.

Please always remember to check your drug book. Some meds cannot be crushed/broken/cut in half, like extended-release type drugs.

Daytonite, BSN, RN · Oct 24, 2005

Giving a lower dose than ordered is not that much of a problem. You circle your initials on the front of the MAR for that particular dose of the medication. On the back of the MAR there is a place for notes. This is where you would make a notation for that particular dose that the patient insisted on taking the specific fraction of the pill, that you notified the charge nurse. This has to be done each time the patient does this. It establishes a pattern. The doctor then needs to be notified. When you are having trouble reaching a doctor, it needs to be reported to the DON so she or someone she designates can follow up on this. When I worked days I would call the doctor's offices early in the morning and ask to speak to the nurse. Sometimes that was the closest I could get to the doc. (After awhile I learned the names of the doctor's nurses and in some cases was able to get the unpublished office telephone number, so I could reach them without having to go through the answering service!) I would tell the nurse the problem and that he (or she) needed to get back to us on this situation. If I hadn't heard from them by 4pm I got back on the phone and called the doctor's nurse again. You also need to be charting all your efforts to contact and notify the doc. It can be done on the back of the MAR or in the narrative nursing notes. Good luck with contacting this doctor! They never teach you how to be a doctor-catcher in nursing school. :chuckle

Nurse Ratched, RN · Oct 24, 2005

If this medicine is one of the psych meds that you can check levels on, see about getting an order to do so. Some people need numbers to understand and at least you could document whether or not it's therapuetic at the pts self-prescribed dose (I *really* feel for you - hope you're able to resolve it.)