sneaking meds in food

Nurses General Nursing

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Is it legal in a dementia unit to sneak meds in patients food? They want me to put morphine in her soda and sprinke another dementia med on her food. (she is a really difficult patient aggression and refuses to take meds)

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If she can't act on her rights, and her POAH has approved, it's fine.

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Specializes in Gerontology, Med surg, Home Health.

Nope. Not a good going to do. Why force morphine on someone? It's a fine line and we don't allow it in my facility POA or not.

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ILL check for power of attorney, but still concerned what the state says about it. Where can you find the laws/regulations for medication administration?

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Specializes in Critical Care.

Hmm, are you sneaking the morphine to chemically restrain the patient? If so, not a very good idea. As the previous poster states..."it's a fine line..."

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Specializes in SICU, MICU, BURN ICU, Trauma, CTICU, CCU.

If the patient is unable to make decisions for themselves, then sometimes you have to do things that they don't want. If they aren't capable of knowing what they are taking, understanding the rationale, benefits, risks, etc... then you defer to their dpoa. We restrain people who don't want to keep their endotubes in because they need it to breathe, we give anti-hypertensives to confused people who think we are poisoning them because they will stroke without it. We drop NGT in confused patients who cannot take PO and need lactulose to help them out, etc...etc... examples could go on and on.

Ultimately, you do what is in the best interest of the patient, provided you have legal consent. If the patient is unable to provide that consent, then you go with what their decision make says.

I would be careful in deciding to pick your battles, however. Is it worth it to fight over colace? Probably not, but I am going to fight over a drug that the patient will develop adverse issues if it were stopped suddenly (long term narcotics and psychiatric meds included). If you are going to give the meds per the DPOA and the patient actually does need them, the path of lease resistance might be to mix it into their applesauce.

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Specializes in SICU, MICU, BURN ICU, Trauma, CTICU, CCU.
im new to nursing, whats a POA?

power of attorney. the patient's legal decision maker when they are unable to make their own decisions.

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Ish.

Once you do really know them, you know when they are actually in pain. If you can't get the meds in due to confusion on their part... as we know oral sensitivity is a big problem with that crowd eg spitting out food, biting on a thermometer, etc. The reaction is automatic to reject a pill, it's innately fearsome to swallow something like a pill for them, but they can't remember/grasp why anymore. Same reason you sometimes can't take a bood pressure. Sure it's uncomfortable, but they cannot hold onto the fact that it's temporary, and all will be OK.

You got to have patience, and have built a relationship with them. More often than not, you can coax if you do have a relationship of trust, even in severely ALZ/DEM patients. I can.

You have to discuss with POA and MD, or one day realize the suffering that may have gone untreated. How crappy you'll feel then. The CNAs if they are good and have been around for a while will know this too.

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Specializes in Critical Care.

In my state this requires a court order, although it can be done for up to 14 days with the order of two separate physicians.

My state law also differentiates between a POA and a surrogate with only the surrogate being able to make decisions such as this. A POA is someone appointed by the patient to make decisions on their behalf if they are unable to do so but only for temporary or short term reasons. For longer term issues, such as demential, the courts a "surrogate" who could be the POA or a state provided surrogate.

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Specializes in LTC Rehab Med/Surg.

COPD pt who can barely breathe and talk at the same time. That's their baseline. Pt refuses the routine Ativan......I don't even remember the reason.

Without the Ativan they eventually progress into a full blown anxiety attack, sats in the 70's and it takes HOURS to get them stable.

Would you sneak them the Ativan the next night, or go through the same scenario again?

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Specializes in Gerontology.

Sure, hide the meds in their food, which makes the food taste funny.. And then wonder why they stop eating. Seriously, if someone gave your food with something hidden in it,what would you do that next time that person offered you food?

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Specializes in Critical Care.
COPD pt who can barely breathe and talk at the same time. That's their baseline. Pt refuses the routine Ativan......I don't even remember the reason.

Without the Ativan they eventually progress into a full blown anxiety attack, sats in the 70's and it takes HOURS to get them stable.

Would you sneak them the Ativan the next night, or go through the same scenario again?

I certainly wouldn't give them a med they refused. Are you saying you would?

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