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

[anonymous1919]

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?

[oryxandcake]

If you're new, you could always ask others what patients are more inclined to refuse meds and make a point of assessing them prior to med admin. It also would be good to find out why they don't want to take the medication in the first place. For example, if it is because lasix is making them urinate often and they're incontinent - maybe have them toileted 30/1 hour after the medication is given.

If you can, avoid pre pouring or crush them at bedside. It may be more difficult, but it is best practice.

[caliotter3]

I consider B/P med to be important, but others may not drop everything to call the doctor at that moment. What is your facility policy? Follow facility policy if you have questions about a particular situation or an ongoing situation.

[healthstar, BSN, RN]

I was taught in school that when you administer meds...you first have to tell the patient what you are giving....and also show him/her the colors because sometimes they freak out when the pill is in diff color....this way they can tell you ahead of time what they don't want....because once you crush them there is nothing you can do but waste all those meds and money.

[SuesquatchRN, BSN, RN]

I was taught in school that when you administer meds...you first have to tell the patient what you are giving....and also show him/her the colors because sometimes they freak out when the pill is in diff color....this way they can tell you ahead of time what they don't want....because once you crush them there is nothing you can do but waste all those meds and money.

When do you get out of school? Because that sure doesn't work with 20-30 demented folks.

[Well-Seasoned]

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.

I agree with this philosophy. However, being honest and if the pt can swallow them all without difficulty I would be more likely to say "oh..I just happened left that one today" (as long as it was not a prn or a med she had c/o side effects with...I know..its not exactly PC..just being honest

[healthstar, BSN, RN]

When do you get out of school? Because that sure doesn't work with 20-30 demented folks.

In my clinicals my instructor always told the patients what meds she was giving. She said, "you always have to let patients know what meds you are going to give even if he/she has been on those meds for years." I don't know what you would do with demented folks.

[CT Pixie, BSN, RN]

A refusal of any med in my LTC facility warrents the same thing. Mark all the refused meds on the MAR (we are computerized). Chart the refusal of the meds (how many times attempted, the residents reason(s) for refusal if any), resident gets placed on the Doc board for when the docs call in for their updates (at least 3 times per day they call). Notify the family.

If you discover that Mary will take one bite but not a second, that's when you just get the important ones in.

When I notice a particular resident will only take one bite what I try to do is use as little "filler" (applesauce, pudding, whatever I'm using) and mix the meds in it. Some of my residents will take it with as little applesauce as possible. so i crush up the meds and mix in enough applesauce to make it all stick together.

Whenever this subject comes up in discussion, it is stated that this is the reason why one should give meds separately.

Never going to happen . Most of my residents will not take more than one bite (not matter how big or small that bite is) If I were to crush up 6 different meds and try to spoon applesause or whatever into their mouths 6 times, I'd probably end up with a face full, a shirt full, over totally covered in crushed meds in applesauce

To the OP, I'd take note of the MAR and see if there are any meds that the resident tends to refuse, keep that one out of the mixture..or, crush up each med, mark the med cups w/what med is in it, bring in a med cup of applesause or whatever you use..find out if the resident will be taking all the meds or if not, which ones are they refusing..then pour all the crushed ones into the applesauce, minus the refused one..that way, you're only "wasting" one med, not all of them.

[itsmejuli]

Out of the 20 residents I care for only one wants to know what meds he is receiving every time I pass his meds. The rest either already know what they're getting at a certain time or they don't care.

Some occasionally refuse their meds, I just chart in the MAR what meds were refused.

[Forever Sunshine, ASN, RN]

In my clinicals my instructor always told the patients what meds she was giving. She said, "you always have to let patients know what meds you are going to give even if he/she has been on those meds for years." I don't know what you would do with demented folks.

You can't with dementia patients.. crush the pills.. mix it with applesauce or pudding. and give it to them. If you tell a dementia patient what they are getting.. they aren't going to know. or remember that they are even on that pill.

There are a couple of patients who I do have to tell them what they are getting to get them to take it. If the patient is alert and oriented, then yes you can go that white one is a pain pill, that green one is for your blood pressure.. and the two red ones are a stool softener.

[CapeCodMermaid, RN]

We don't notify the doc unless the resident has refused for 3 days in a row. Honestly skipping a med or two here or there probably won't have a negative outcome. If the person has CHF and needs their lasix or AFib and really needs the dig, I played let's make a deal...come on Sally..just take these 2 really important ones and you can skip the rest today. You have to find out what works for your patients. We had one guy refusing his lactulose almost every time we offered it. When we switched to a different brand which was a different color, he took it without a problem. You'll find what works best for you.

[kids]

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."

Actually she'll do what her facility policy says she's to do. She may have to call it to the doc herself. Or write it out & fax it, put it on the call list for the charge nurse or in the doc log for rounds.

But never, ever document "physician notified" unless you personally spoke the the doc, his on-call or his office staff. If you notify a doc via fax, document s/he was notified via fax.

[SuesquatchRN, BSN, RN]

Actually she'll do what her facility policy says she's to do.

True dat.