Resident Resistant To Taking Meds

[tqfamily]

I am the Resident Care Supervisor at a Retirement/Assisted Living facility. When we nurses administer medication we have several residents we have to supervise take their meds because they forget to take them. We have one resident who is very very resistant and takes 30 to 60 minutes EACH med pass to take the meds (4 med passes per day) Obviously, we do not have that kind of time to spend each med pass. It is very behavioral , this resistance. I am just looking for some input on what we should do …. 

[hppygr8ful, ASN, RN, EMT-I]

It’s easy. Since the residents have the free will to take their meds or not simply document the residents hesitancy and move on. I might also suggest scheduling a care conference with patient and their family to discuss these issues and reduce the number of medications to those absolutely necessary. If the family knows what’s going on it would release you and the facility’s liability should the resident decline due to not taking medication.

hppy

[tqfamily]

Thank you so much for your input … so many views and only one response … I’m thankful for the input that’s all I want. 

[JKL33]

It would be interesting to know the root of the hesitation. Could even be something like loneliness, you know? Care conference is a great idea and maybe this is one of the things that can be ferreted out a little.

Good luck ~

[VivaLasViejas, ASN, RN]

Long-term care residents are some of the most over-medicated people in the world. Not just with prescribed meds, but with useless vitamins and supplements. Why does a 90-year-old with severe dementia and swallowing difficulties need 20 pills morning, noon and night? Sometimes residents don’t like to take meds on principle—I remember an old gent I cared for who had 17 pills first thing in the morning, and he routinely refused everything because “the doctors are trying to kill me with all these pills”. I was able to get all the supplements d/c’d except for a multivitamin and (very) necessary bowel care, and he grudgingly accepted these and his blood pressure meds in ice cream. 
 

I agree that a care conference with the resident and family is in order, also bring his or her doctor in if possible. Sometimes residents have very good reasons for not wanting to take their medication, e.g. side effects like excessive daytime sleepiness, frequent urination, and dizziness on standing. You can also ask for a psych eval if the difficulty seems behavioral in nature.

 

[MunoRN, RN]

If the patient is hesitant to take the meds then staff should be recognizing that and should not be further pressuring the patient to take them.  

Acknowledge their right to decline the medications and move on.

[amoLucia]

Another often overlooked side effect is DRY MOUTH. Like Sahara Desert dry mouth! And they may not even recognize the dry mouth as a side effect, just they hate pills. (Take this personally!)

PP Viva wisely suggested reviewing meds for a reduction, time changes, combo meds, generics, etc. Arrange to cut whatever can be cut. 

At ALs/Retirement Centers, do you have a facility pharmacy consultant? They can help tremendously to streamline med admin.

I'm sure families will be interested in decreasing med costs if poss, so care conferences are indicated.

[Tenebrae, BSN, RN]

Drop "behavioural" from your vocabulary.

Its not a good word in most nursing contexts. It implies that the patient is doing something "just to be annoying" 

Often patients feel that they have no power in a situation so they will take power in anyway possible. 

As someone else has said, do some work and see if you can find out what is causing the patients resistiveness. It could be something as simple as not liking the taste of the medication. It could be that they have a poor memory and cant remember what the meds are for. In which case you have the opportunity provide her with a list of her meds and a brief description of what they are for. 

Patient education is shown to vastly improve compliance with treatment.

My supervisor said it really well when I was dealing with a similar situation "what is the behavior trying to achieve". I think if you are able to find out the cause of her resistance, you will crack the case

[hppygr8ful, ASN, RN, EMT-I]

7 hours ago, Tenebrae said:

Drop "behavioural" from your vocabulary.

Its not a good word in most nursing contexts. It implies that the patient is doing something "just to be annoying" 

Often patients feel that they have no power in a situation so they will take power in anyway possible. 

As someone else has said, do some work and see if you can find out what is causing the patients resistiveness. It could be something as simple as not liking the taste of the medication. It could be that they have a poor memory and cant remember what the meds are for. In which case you have the opportunity provide her with a list of her meds and a brief description of what they are for. 

Patient education is shown to vastly improve compliance with treatment.

My supervisor said it really well when I was dealing with a similar situation "what is the behavior trying to achieve". I think if you are able to find out the cause of her resistance, you will crack the case

OMG I love your answer - So much so that I will find a way to share it with my treatment team at work

 

[Tenebrae, BSN, RN]

17 hours ago, hppygr8ful said:

OMG I love your answer - So much so that I will find a way to share it with my treatment team at work

 

Cheers. 

I remember once looking after a patient with dementia who would always ask me about her medication. "that one is for your blood pressure, helps keep it at this great level, that one helps take the water away from your heart and keep it working well, and that one helps prevent aches and pains'. A colleage said 'you know she will ask you again tomorrow'. The colleage was right. I also never had an issue with that lady taking her medications. Maybe took me an extra couple of minutes

I fiercely believe that someone can be severely impaired due to mental illness, dementia and other illnesses, if they understand even in the moment they are coming at it with informed consent, and are much more likely to be compliant. 

There are always exceptions I have also had others (usually dementia or something similar) who absolutely would not take their pills, wouldnt take them mixed in with food from me. Often I would give the meds to a caregiver (because the patient has made the connection between my uniform and medications) while I observe from a distance and check with the caregiver whether they took it (in those cases the patient has an activated EPOA who has given their consent to receive medication). Its a good opportunity to get the GP to rationalise their meds, for example Mrs Smith in bed 1 was prescribed losec as a preventative against side effects for another med 10 years ago and its never been stopped

But importantly if patient won't take their meds within a reasonable length of time I would document in the notes "Mrs S refused her medications. Multiple attempts made to administer medication, education provided, Mrs S still refused. Handed over to next shift and to continue to monitor" or something

 

[TaylorHM1992]

I am home health (I specialize in wounds and psychiatry, weird combo?), therefore I go to many facilities.

Most recently, one of the facilities called me because one of the patient's I follow was refusing all medications. 

What I did and it worked: I sat down with him and printed out a list of his medications. I wrote down what they were used for. I then asked what about the medications he doesn't like. He stated he doesn't think he needs all "the stupid vitamins" (he was taking a lot). He also stated that they were coming in 4x a day and he didn't like that. I asked if he would continue taking them for now until I spoke with the doctor and he agreed. 

I went to the facilitie's MD and explained his view so his MD ordered labs for everything and basically discontinued all of the vitamins and condensed everything into 2x/day. 

That was about a month ago and he has remained compliant since. 

[amoLucia]

TY for your advocating for your pt.