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

Specialties Geriatric

Published

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?

Specializes in LTC.
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.

I have a patient who CONSTANTLY REFUSES .. her medications. Her daughters have signs up all over her room "Mary's Daughters want her to take ALL of her medication EVERY SINGLE DAY" .. still refuses. The resident states that "I have rights and I have the right to refuse my medication." But I won't take no for an answer with her. I pull down the blankets.. I'm like "Look at your arms.. look how swollen they are. ".. She says.. "I like them that way".. I tell her "No.. you don't. and thats very very unhealthy to keep your body so swollen.. just take the lasix for me. I'll crush it and put it in chocolate pudding. "Fine". and then Its a done deal.

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Specializes in Gerontology, Med surg, Home Health.

I wouldn't allow any signs like that to be posted in a resident's room. It's certainly not dignified and could be argued it violates her rights. Is the daughter the health care proxy and has it been invoked? I wouldn't pull blankets off someone either...could be construed as abuse.

PS MY daughter wants me to take MY medicine, too, but that's not going to happen either!

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Specializes in Med Surg, Tele, Geriatrics, home infusion.

you really just have to tailor your approach to fit each resident. So some people get their meds via drink/ice cream/pudding etc. I find dementia patients it's more their relationship with me. Chat with them a minute, get them relaxed. I think many of them refuse us because we're just this strange person trying to feed them a bite of nasty smelling/ tasting applesauce concoction. Get it tasting better and be friendly and it helps a lot.

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Specializes in Med Surg, Tele, Geriatrics, home infusion.

Generally people refuse all their meds not a particular one. Or they only take 1 bite so like many other posters have said you have to make that bite count! The 2 things people generally refuse specifically are diuretics and bowel meds. How I respond depends on why they're refusing. IE they have an appt sure that's reasonable. Is it good for them no not really but it won't kill them to miss a dose if they still refuse educate and document. Now if they refuse for fear of incontinence re-assure them ie. I'll take you myself if there's no one else avail. Also find out if they really are having bms. Maybe they genuinely are having loose stools and people aren't marking it.

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Specializes in LTC.
I wouldn't allow any signs like that to be posted in a resident's room. It's certainly not dignified and could be argued it violates her rights. Is the daughter the health care proxy and has it been invoked? I wouldn't pull blankets off someone either...could be construed as abuse.

PS MY daughter wants me to take MY medicine, too, but that's not going to happen either!

Her daughters are her health care proxy. I don't mean rip the sheets off forcefully.. I pull the blanket down so I can see her arms, in which she has pitting edema. When she is on my assignment, she eventually will take her lasix after encouragement and education on why she needs to take it.

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Specializes in LTC.
Generally people refuse all their meds not a particular one. Or they only take 1 bite so like many other posters have said you have to make that bite count! The 2 things people generally refuse specifically are diuretics and bowel meds. How I respond depends on why they're refusing. IE they have an appt sure that's reasonable. Is it good for them no not really but it won't kill them to miss a dose if they still refuse educate and document. Now if they refuse for fear of incontinence re-assure them ie. I'll take you myself if there's no one else avail. Also find out if they really are having bms. Maybe they genuinely are having loose stools and people aren't marking it.

I have one resident who takes 1/4 of a teaspoon or less per bite. It takes FOREVER to give her medicine.

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Specializes in Med Surg, Tele, Geriatrics, home infusion.
I have one resident who takes 1/4 of a teaspoon or less per bite. It takes FOREVER to give her medicine.

lol HATE that. Try convincing them to take it in a supplemental drink? long as they aren't a diabetic ice cream and pudding work much better than applesauce.

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Specializes in LTC.
lol HATE that. Try convincing them to take it in a supplemental drink? long as they aren't a diabetic ice cream and pudding work much better than applesauce.

I use chocolate pudding with her. But after awhile it becomes liquidy(cause she takes so long to eat 15ml of pudding and crushed pills lol). So I will take a little bit this chocolate supplement shake stuff she has on her tray and mix it with that. Still took forever.

She likes juice though. Might try mixing her meds with juice next time instead of pudding. Shes not thickened liquids and they give her regular juice on her tray.

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Specializes in LTC, assisted living, med-surg, psych.

What I want to know is, does this resident really need to be on 20 meds?? One of the biggest problems in LTC---IMHO---is polypharmacy. For Pete's sake, why are we spending valuable nursing time trying to force a snootful of meds down a resident who doesn't want them, doesn't even NEED half of them, and isn't benefiting from many of them?

I mean, unless they've got wounds, they usually don't need a fistful of vitamins. If they are given proper fluids and encouraged to move around as much as possible, not everyone needs multiple bowel care meds. And will someone please tell me what is the purpose of giving elderly people medications that make them miserable? I don't blame people a bit for refusing 'water pills' and meds that, when crushed, make the medium in which they're stirred taste like poison and leave a nasty film on their tongues. Blech.

Sounds like some radical surgery needs to be done on the MARs, especially when residents come back from the hospital with a ton of new Rx. If we don't protect residents from being overmedicated, who will?

Just my two pence worth.......

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Specializes in Post Anesthesia.
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.

I think you have the makings of the next VP of "Baskin & Robbins" 'The flavor of the mos is NARCOTIC and we recommend a nice three scoop narcotic sunday with hypnotic sauce and a nice sprinkeling of crushed SSRIs. Don't forget the seconol cherry!'

I'm not making fun- I love your description.

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What I want to know is, does this resident really need to be on 20 meds?? One of the biggest problems in LTC---IMHO---is polypharmacy. For Pete's sake, why are we spending valuable nursing time trying to force a snootful of meds down a resident who doesn't want them, doesn't even NEED half of them, and isn't benefiting from many of them?

I mean, unless they've got wounds, they usually don't need a fistful of vitamins. If they are given proper fluids and encouraged to move around as much as possible, not everyone needs multiple bowel care meds. And will someone please tell me what is the purpose of giving elderly people medications that make them miserable? I don't blame people a bit for refusing 'water pills' and meds that, when crushed, make the medium in which they're stirred taste like poison and leave a nasty film on their tongues. Blech.

Sounds like some radical surgery needs to be done on the MARs, especially when residents come back from the hospital with a ton of new Rx. If we don't protect residents from being overmedicated, who will?

Just my two pence worth.......

Exactly what I've been thinking while reading this thread.

Gotta get the docs to reassess and take some of the meds away.

It is crazy to take 20 pills. :uhoh3:

steph

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Specializes in LTC.
I think you have the makings of the next VP of "Baskin & Robbins" 'The flavor of the mos is NARCOTIC and we recommend a nice three scoop narcotic sunday with hypnotic sauce and a nice sprinkeling of crushed SSRIs. Don't forget the seconol cherry!'

I'm not making fun- I love your description.

lol and sennakot crumbs. The funny thing is .. this lady is A+Ox3. But after 2 spoonfuls(sometimes 3.. hence the need for parfait).. she says "no more my stomach can't take it"

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