What's your policy on med refusal?

[GLORIAmunchkin72]

Ours is we have to show that we tried at least 3 times and tried different approaches.

Last night I was attempting to wake a resident to give her her 7'oclocks. (These are really 8pm meds but if she doesn't get them by 7pm she calls the desk). She normally wakes up with a little nudge, but that didn't work. Seeing that she looked out of it I decided to return an hour later. And I did. Same response but this time she flailed her arm and mumbled "leave me alone". I reported this to the nurse. A little while after that the nurse decided that maybe a two-person approach (and the presence of a nurse) might do the trick. This time the resident was not in bed and was being wheeled out of the bathroom. She knew what was up and I thought she was going to get her shotgun. Totally exasperated she told us in no uncertain terms that she DID NOT WANT ANY MEDICINE.

I feel kinda bad about this situation because this resident usually takes her medicine. (But she has been known to throw her pills in the trash when she is upset).

I think in the future I will definitely leave her alone.

[Pepper The Cat, BSN, RN]

Pts have the right to refuse medication. We write "refused" on the MAR. If its an ongoing issue, we try and change to times of meds to meal times when the pt is usually alert and sitting up. Why does she not take her meds? Side effects? Problems swallowing? What meds is she refusing. If its something vital like cardiac than you need to work with her to get her to take them. If its tylenol or colace or vitamins she may not really need them, so re-evaluate them.

[yadda_yadda_yadda, LPN, LVN]

Everywhere I've worked, the policy is pretty much the same as you've mentioned (3 tries, different approaches)--- The one thing I never forget to do is document it completely....Making certain to add... " potential risks of med refusal discussed at length with patient. Patient accepts these risks. Charge nurse aware of refusal." ---Then, make certain that the patient is monitored closely (if it were B/P meds, or something critical)---and pass the information on in shift report so additional monitoring can/will be done.

[GLORIAmunchkin72]

Like I said before, she normally takes her meds for me. I think she was just extremely sleepy. I can understand why after taking xanax at 5pm. (And for really good reasons but I am not going to go into that).

Pts have the right to refuse medication. We write "refused" on the MAR. If its an ongoing issue, we try and change to times of meds to meal times when the pt is usually alert and sitting up. Why does she not take her meds? Side effects? Problems swallowing? What meds is she refusing. If its something vital like cardiac than you need to work with her to get her to take them. If its tylenol or colace or vitamins she may not really need them, so re-evaluate them.

[Tweety, BSN, RN]

Everywhere I've worked, the policy is pretty much the same as you've mentioned (3 tries, different approaches)--- The one thing I never forget to do is document it completely....Making certain to add... " potential risks of med refusal discussed at length with patient. Patient accepts these risks. Charge nurse aware of refusal." ---Then, make certain that the patient is monitored closely (if it were B/P meds, or something critical)---and pass the information on in shift report so additional monitoring can/will be done.

Good point about documenting that teaching was provided about what the medicine is for, what could potentially happen by not taking it.

[TheCommuter, BSN, RN]

When a patient refuses their medications, I will take a few actions.

1. On the MAR I will write 'Refused'.

2. In the nurses' notes I will chart 'Attempted to administer meds x3; patient refused. Offered to crush pills and mix with jelly or pudding; patient refused and stated, "I don't want it." Educated patient on consequences of not taking scheduled meds; patient states, "I understand." Staff will continue to monitor. Call light within reach; pt. states will call PRN.'

[Antikigirl, ASN, RN]

Three declinations, after telling the pt about the risks in detail dependant on situation. If the situation is that a pt is unable to comprehend or make their own medical judgement...I keep on trying very carefully and illicit the help of family, MD's and administration if necessary with all information documented fully!!!!

Typically if I go away for a while, gain trust with other procedures or ADL's, I can get them to take medications or procedures (my worse is any sticks...CBG or insulin...I have many that decline...I will find out if they wish to do it themselves...if that is cool I watch them. If not...on to trying later, calling MD and administration help PRN).