sneaking meds in food

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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)

My main concern besides the patients is my license, I just got it, worked hard for it and its not worth losing it over this. She can be a danger to other patients, she gets agitated and picks on people. But she does it regardless of the medication. There is no mention of this in the mar/tar only the nurse orienting me has told me to do this. Im afraid to go to the supervisor now because Ive already given it to her in her food because I was told to by my preceptor, only to rethink it when I got home. Guess I will check the POA and write a note to the doctor.

Thanks for all the replies, its good to talk to other nurses!

Yeah- and if there is no psych evaluation with recommendations, I'd ask for one :)

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.
Carolmacca...we in the States are NOT allowed to force anyone to do anything in LTC and we certainly are not allowed to hurt them. And, yes, I've been hit ,kicked, and a resident tried to choke me.

Yes, I understand that. But, as I said where I am, we are taught self defense techniques, and we can ONLY use them to get the patient off of you and to protect yourself. If you have to hurt them, you have to. But you can't keep hurting them if they are off of you for example.

We are taught your life is more precious than any patient. And yes, I've been half strangled, punched in the head, and in the bad old days, you weren't allowed to touch patients. Lucky there was an orderly there that day and he managed to force the guy's hands from around my neck until everyone else came running up & restrained the patient. I felt like my eyes were going to fall out my head. Had finger mark bruises round my neck and all.

Not fun :(

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

Interesting discussion BTW. It's good reading everyone's diff viewpoints.

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Specializes in Long term care, rehab.
My main concern besides the patients is my license, I just got it, worked hard for it and its not worth losing it over this. She can be a danger to other patients, she gets agitated and picks on people. But she does it regardless of the medication. There is no mention of this in the mar/tar only the nurse orienting me has told me to do this. Im afraid to go to the supervisor now because Ive already given it to her in her food because I was told to by my preceptor, only to rethink it when I got home. Guess I will check the POA and write a note to the doctor.

Thanks for all the replies, its good to talk to other nurses!

If it is truly weighing that heavily on you then the solution is simple. Call the MD and see if you may have an order that states "May give meds in food or drink",then make sure to notify the POA. That way everyone is covered. But honestly, it's not a big issue. Just something to do when you get to it.

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Specializes in CICU.

I work acute care, but if I can't get a confused patient to swallow pills I usually can't get them to take anything by mouth, either. Too often, even if they are cooperative but confused, they will swallow the pudding and pick the pill back out of his or her mouth and hand it back to me =)

If it is something I feel is critical (cardiac meds, ativan, etc) I will call the doc and ask for something IV.

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Specializes in ICU.

Why are you concerened with the medium you are using? You hide other people's meds in pudding/ applesauce and don't question cause that's the norm. I work LTC too as agency I have one client who gets meds crushed in juice and if she sees me with her juice she won't drink it. Another client we " hide" it in her meat. I take med cup full and use the meat as my medium. Is the POA, involved? If you call them, they will likely tell you they know and call tell you what works best for the client. I would only make sure there is an order to crush meds and go on. Also, try giving the meds in the normal fashion and see if you don't end up wearing them home. if she takes them in your normal medium then continue with that. My other concern is when you are giving the meds are you sprinkling and walking away. I wouldn't do that if there are surveyors in the house, you might get the facility a ding. Make sure you are the one giving the meds. Also, you said you put the morphine in juice, is it liquid concentrated morphine? If so that stuff burns due to the concentration so mixing may be to prevent the burn.

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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?

*My* State is OK with it but that doesn't matter, what matters is what *YOUR* State says. There is no universal "the State".

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.

I usually agree with you but not on this.

A patient has the right to appoint a PoA for health care when they can no longer speak for themselves, disregarding the wishes of a PoA is violating the patients rights.

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.

My thoughts (and experience) exactly. You can no more ignore a (legal) decision by a PoA than you can one made by a competent adult or court appointed guardian.

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?

In LTC a family member without a supporting legal document does not have the legal right to make decisions (tho it is often allowed as a courtesy). The way it's supposed to be done is that social services and the doc get involved, the appropriate mental status testing and tons of documentation and then it's care planned.

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Specializes in LPN.

In our facility we get an order to put get meds in food and drink. That way you can do it with out worrying about it. I did like the idea of the medium you use to give meds. If we couldn't put meds in foods, then you can't use applesauce or pudding either. I think a little commen sense goes a long way, except when state is in the building. That is the time to turn off your brain and become a robot.

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Specializes in Gerontology, Med surg, Home Health.

I've had family members who were e HCP, invoked, tell me to hold down their faimily member if necessary to get their antipsychotic meds into them. Health Care Proxy or not, I am not holding anyone down to give them anything.

Tiroka..the rules are the rules for a reason. It isn't robotic to follow standard, evidenced based procedure.

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In LTC a family member without a supporting legal document does not have the legal right to make decisions (tho it is often allowed as a courtesy). The way it's supposed to be done is that social services and the doc get involved, the appropriate mental status testing and tons of documentation and then it's care planned.

Precisely. And, another good reason for EVERYONE to have advanced directives with a POAH. :up:

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