What is procedure when patient is unable to take medicine?

I've had two patients over the weekend who were unable to take ordered medication (one from nausea and the other deemed it unnecessary). In both cases I waited an hour and returned to try again. For this I'm in a bit of trouble , and next time I'll consult immediately.

However my supervisor can't point to a written policy for when a patient refuses or is unable to take an ordered med. I agreed to work on this together with her.

Ideas? What is your written policy?

-Marnie
It's their right to refuse it, try again within the hour before/after and then circle it refused if they do it again.

In all cases, re-appproach within 20-30 minutes, and report to next level supervisor the patients responses.Always notify the doc, in the case of nausea...Get an antiemetic order, and an order to have the meds taken 90 minutes(apx, use your judgement) after/within antiemetic.No matter what you do, they wont take the med?Declined to take the med (cognitively intact) and understands the consequences.Note that education provided, res continued to decline to take meds ordered by MD.Refused to take the meds(cognitively impaired) consequences shmonsequences...im not doing it until the dog is let out.Note that education attempted to patients comprehensive level, pt. continued to refuse the med.Rejected the med (cognitively intact) had been taking the med and now does not want to.Note that education was provided, and residents reason for stopping med is noted as well.Documentation and f/u. documentation and f/u. documentation and f/u.

It is not your fault if they refuse. Any patient has that right.In the case of nausea you could try an antiemetic before hand (in suppository form if needed). What kind of "policy" was she going to put in place? You can't force someone to take their meds.

Depending on the medication, it may not be a bad idea to call and just let the doctor know.

Quote from SitcomNurseIn all cases, re-appproach within 20-30 minutes, and report to next level supervisor the patients responses.Always notify the doc, in the case of nausea...Get an antiemetic order, and an order to have the meds taken 90 minutes(apx, use your judgement) after/within antiemetic.No matter what you do, they wont take the med?Declined to take the med (cognitively intact) and understands the consequences.Note that education provided, res continued to decline to take meds ordered by MD.Refused to take the meds(cognitively impaired) consequences shmonsequences...im not doing it until the dog is let out.Note that education attempted to patients comprehensive level, pt. continued to refuse the med.Rejected the med (cognitively intact) had been taking the med and now does not want to.Note that education was provided, and residents reason for stopping med is noted as well.Documentation and f/u. documentation and f/u. documentation and f/u.

Quote from loriangel14...It is not your fault if they refuse. Any patient has that right.In the case of nausea you could try an antiemetic before hand (in suppository form if needed). What kind of "policy" was she going to put in place?

Quote from SitcomNurseIn all cases, re-appproach within 20-30 minutes, and report to next level supervisor the patients responses.Always notify the doc, in the case of nausea...Get an antiemetic order, and an order to have the meds taken 90 minutes(apx, use your judgement) after/within antiemetic.No matter what you do, they wont take the med?Declined to take the med (cognitively intact) and understands the consequences.Note that education provided, res continued to decline to take meds ordered by MD.Refused to take the meds(cognitively impaired) consequences shmonsequences...im not doing it until the dog is let out.Note that education attempted to patients comprehensive level, pt. continued to refuse the med.Rejected the med (cognitively intact) had been taking the med and now does not want to.Note that education was provided, and residents reason for stopping med is noted as well.Documentation and f/u. documentation and f/u. documentation and f/u.

Quote from Esme12... WHat is the policy at your facility. It matters if you did not follow the ploicy of you facility.....or your supervisor is a control freak. .

If someone is unable to take one form of a medication (nausea, inability to swallow, etc.) what about another form--suppository, sub-lingual, IM, IV?

The beginning of this instructional video shows the "best evidence" method of delivering the medication. Numerous other lessons are presented for your instructional pleasure. http://www.youtube.com/watch?v=oyNnKYS29SYPay particular attention to denture repair at 1:44.

Quote from Marnie SThis is super helpful. Thank you! Is this your personal policy or based on a written standard? -Marnie P.S. In my first case, patient was cognitive, but unable to ingest Coumadin tab due to nausea. In the end, the patient didn't get the med at all and I didn't consult (nor did the next shift) which is where I think my biggest mistake was. Thus my penance of researching what policy is at other organizations or definition of standard of care.

OK I think we've drifted away from creating a written procedure to talking about patient's rights Which is a very valid issue, but not what I'm looking for here Where I need help is in coming up with a written care standard for when it's necessary to consult with the doctor when the patient is unable to take a medication. Of course what I'd really like to know is... What is YOUR organizations' written policy describing the procedures when a patient is unable to take a med? Can you share it?-Marnie