Refused only 1 med but they're already all crushed together?

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Specializes in Geriatrics.

In LTC (I don't know if this is wrong to do..) a lot of times residents will have a 20 pills in the AM and need them crushed.... So if you get them all crushed and in apple sauce and present it to them and they refuse one of the meds in the mixture but want the other 19.... what do you do? Oh and how often does this happen?

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It's never happened to me.

I do crush the most essentil separately than others for some because I know I MIGHT be able to get some in but not others. So I try to get the metoprolol, lasix, etc in and worry about the MVI and calcium if I get the important ones in.

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Specializes in Geriatrics.
It's never happened to me.

I do crush the most essentil separately than others for some because I know I MIGHT be able to get some in but not others. So I try to get the metoprolol, lasix, etc in and worry about the MVI and calcium if I get the important ones in.

That's a great idea. I just graduated my LPN program and I am looking for a job in a nursing home and I'm def going to do that! I'm really trying to go back to the nursing home I worked at as a CNA on the Alzheimers unit and I have no doubt they are challenging when it comes to med administration.

But would you just toss the meds and get the ones they only wanted? Are you allowed to do that or what?

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The resident has "the right to refuse." So, yes, you can do this. I wouldn't bother initially. If they don't want them leave them on the cart and come back in five minutes. The rule of thumb is attempt to give the meds three times. If you discover that the resident repeatedly refuses meds report it to the doc, and always write a nursing note that they refused. If you discover that Mary will take one bite but not a second, that's when you just get the important ones in.

If someone states clearly, "I refuse to take the pee pill" gently explain that it helps their heart to work better. If they still refuse omit the pill and - wait for it - write a nursing note and inform the MD.

:)

Yes, I will toss meds they won't take.

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Specializes in Long term care.

If the patient routinely refuses only one medication, maybe go in the room before you crush all of the pills and see if they are gonna take the med that day or not....and don't forget to document that they refused the medication.

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Specializes in Geriatrics.
The resident has "the right to refuse." So, yes, you can do this. I wouldn't bother initially. If they don't want them leave them on the cart and come back in five minutes. The rule of thumb is attempt to give the meds three times. If you discover that the resident repeatedly refuses meds report it to the doc, and always write a nursing note that they refused. If you discover that Mary will take one bite but not a second, that's when you just get the important ones in.

If someone states clearly, "I refuse to take the pee pill" gently explain that it helps their heart to work better. If they still refuse omit the pill and - wait for it - write a nursing note and inform the MD.

:)

Yes, I will toss meds they won't take.

How would you document it "Patient refused medication administration x3. Doctor notified" ?

Sorry- I'm full of questions. Who ever I follow is going to hate me ha ha!

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

lol...dont ya just love ltc

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Sorry- I'm full of questions. Who ever I follow is going to hate me ha ha!

By George, she's got it!

BTW, you won't call him. You'll write her a note on the MD list for when she comes in that says, "Hasn't been taking meds. See NN."

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Specializes in Psych.

At my hospital we have a little hammer in the med room. The pills are hammered/crushed in the package they come in and are opened at the bedside.

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Specializes in LTC.

Just toss it and make a new one.

I have a patient who I have to make a "parfait" for. Non-important meds go on the bottom.. B/P and her reglan go in the middle. and narcotics go on top.

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Whenever this subject comes up in discussion, it is stated that this is the reason why one should give meds separately. However, having worked in LTC facilities with their med passes from hell, nobody has time to do it that way. I would take the advice of asking before your prepare. You might get lucky. And chart it the way you said, that is the way we charted it, except we didn't necessarily call the doctor immediately unless very, very important.

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Specializes in Geriatrics.
Whenever this subject comes up in discussion, it is stated that this is the reason why one should give meds separately. However, having worked in LTC facilities with their med passes from hell, nobody has time to do it that way. I would take the advice of asking before your prepare. You might get lucky. And chart it the way you said, that is the way we charted it, except we didn't necessarily call the doctor immediately unless very, very important.

Would a refusal for something like a b/p med warrant a call? I mean........ that could get dangerous.

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