1y ago

dol

The medication is a blood thinner, the patient is a competent adult not in delirium, A&OX4. There are 2 ways to see this:

Manager's and a group of doctor's POV: you are a nurse and it's your job and duty to do that. Plus, we know better than him what's good for him. These people have built their identity around working in healthcare and to them this means I have to stay in the room and make sure the patient takes the medication.

My POV: nursing is not a calling but a job. What my manager and these doctors think is stupid:

the patient is a competent adult not in delirium, A&OX4. He's old enough to know what happens if he doesn't take the medication because we have told him a number of times already. I'm not his father and I'm not ready to treat a competent adult like a child.
I have other patients and I'm not going to waste my time watching a patient silently until he decides to take the medication. I'm charting that I left the medication next to him and told him he needs it and why and that I have other patients to take care of.
It is stupid to watch a person while doing nothing when I should be working with my other patients. It's also invasive as f*ck.

I see it like this: my manager and this group of doctors are not ready to respect a person's autonomy whereas I'm not ready to ignore this same autonomy, even if it means a negative outcome. Respecting a consenting adult's autonomy means respecting his bad choices as well. I feel this group of doctors and my manager are not ready to respect any patient's autonomy.

At this moment, this is a hill I'm willing to die on. AITA?

ETA: I wrote about a group of doctors, because there are other doctors that don't give me hard time if a patient refuses his medication, they simply chart it and move on. I like working with doctors like this because I feel they don’t judge and respect the patient's autonomy as well.

15 comments

They want to know IF the patient took it and not that you provided it or forced it down his throat
If something happens to the patient they need to know if he took the medication.
If you only chart that you provided the patient with the medication then they dont know if he took it or they might be under the impression that he took it and if he gets complications from not taking it then they might not give him the dose he needs since they will be afraid of over medicating.
As well as if he did take the medication and got complications from the medicine it self they won't know since they don't know if he actually took it.

I get the autonomy thing and refusing care is cool and all. Totally their right. I just remind them what the adverse outcome for refusal could be, document that and move on. BUT if I'm charting that the patient took the medication, I'm 100% standing there to witness it because I'm not just gonna trust them on it and potentially falsely document. People cheek their meds, pocket them, take them at a later time with other meds to get high, or whatever the hell. DON'T blindly trust patients. But yeah. Basically - I just care about the legalities. Lol
- For me, it's all about reading people. If they're really hmming and hawing, I might ask "what's the matter?" to get a read on their concerns. Remind them of the benefits, that these are MD orders, maybe it's a medication that they shouldn't just stop cold, maybe they wanna talk to the MD first, maybe they had a bad experience and want to take an alternative med instead (and we can make that happen!), etc. Some are straight up scared to refuse😅 So I might remind them hey it's totally your right to not take it. Depends on the patient really. But some give a firm "no" and I don't argue with that.
  Now all of the above is assuming I have time, because sometimes it's just too dang busy. Med pass is usually a 10, maybe 30 seconds max interaction. Keep it moving.
  The staring and angry reactions don't phase me. Maybe it did when I was new. But you develop a thick skin real quick doing this job.
  At the end of the day, med pass must be witnessed or you risk false documentation. It ensures time accuracy in record-keeping too, as in you (and pharmacy, and all other providers) know the patient took it at this time and not an hour/hours later. There are all sorts of med interactions and domino effects to consider.
  As far as the not trusting patients thing - that doesn't just come from nowhere. Obviously it would make all our lives easier if we could just trust people! But you see all types of scenarios in healthcare, whether it happens to you or a coworker. One day you'll chart medication was given, maybe cardiac meds. Come in later and find the pills under their pillow or something. Maybe the patient codes later that night. I mean who knows. Just protect your license and don't do risky shit that gets you burned. Because all it takes is one bad day.

Here's my thoughts as a critical care PA:
If the patient is AOx4 / has capacity and there is no reason to suspect they're throwing out meds (or storing them for a bigger dose later, as sometimes happens with opiates), then I personally don't care if you visualize it, although I share another commenters thoughts that I'm not sure what the big delay is in such patients.
If they're AOx4 and have capacity but there IS suspicion of deception, there needs to be a conversation with the patient, nursing, and the provider team. This patient absolutely has the right to decline medication, and they need to know that they will get better care if everyone is honest with each other.
If they do not have capacity to refuse and there is suspicion that they are unable or unwilling to self administer the medication, yes you must watch them take it.
Edit: for clarification, are the doctors mad that you can't CONFIRM that they took the meds or mad that you aren't CONVINCING a person to take a med they don't want to take?

As far as i know the actual reason for doing this is to know with certainty if they took it or not. This is important for complications such as allergies or over/underdosing medication because you can’t be sure what and how much is in their system right now.
In short, get over yourself and watch them take their meds. It’s not because they are children, but because you need reliable certainty to treat them further without additional risk.

I don't get this, why is there a delay at all? The times I've been in the hospital, they hand me the pills and a cup of water, there's no expectation that I can choose when to take the pill, it's immediate.
- Why? Any number of reasons. Ultimately, it is the patient's choice when to actually take them, or if to take them. There is a degree of realistic limit to that, particularly with dose and time sensitive medication, but you absolutely have that choice within those limits.
  Should you be fucking around and not taking them on schedule? Hell no! Let the pros do their job unless there's a good reason otherwise, and communicate any reason asap so it can get sorted. But it is the patient's right to manage their care as long as they're competent.
  Now, as to why? Dry mouth, sore throat, nausea, concerns about timing of side effects (like drowsiness) interfering with something, there's all kinds of good reasons to delay taking a medication. There's also plenty of bad reasons lol.
  And it's important to remember as a patient that if you're going to fuck around with things that most patients aren't qualified to fuck around with (like dosage scheduling), that most facilities can turn that into a reason to turf your ass lol. It's rare, but hospitals can kick our asses to the curb via transfer or other means if we're unwilling to cooperate with our own care at all.

You're not there to make sure they take it, you're there to document whether or not they took it. That much IS definitely your responsibility, to confirm that they did or did not take their meds. You're not the asshole, you're just looking at it wrong.

I think you may be making a mountain out of a mole hill. If they're asking you to make him take it, we all know that's a violation of informed consent to medical treatment laws/practices/standards. It doesn't sound like that though. It seems as if they just want you to document whether the patient takes it or not. If they're alert and oriented, it should be obvious when you give it to them whether or not that happens within, say 10 seconds. 10 seconds isn't really invasive. If the patient gets upset that you're watching him take it for that long, pass it off as you're just documenting whether or not he took it.
If they are wanting you to make the patient take it, well... bring up concerns to a supervisor you trust, and chart that you spent time trying to convince the patient to take the medication (better known as, the 5 seconds you talked to the patient about this being a doctor's orders for medication).

If you document that you gave it, you need to have seen them take it. If they’re being stubborn and are competent, document that you educated them on the consequences and that they still refused.

Wouldn't it be worse for other patients if he stays in hospital longer because he made himself sick from not taking medicine rather than just making sure he does to clear the bed sooner?

My partner is a med tech. Unless it states otherwise on their chart/care plan, she always makes sure those meds get taken. It can be uncomfortable or awkward, but depending on the residents level of ability there is no way to determine their safety, whether they remember to take it, etc. Is it unfortunate that we can't trust their autonomy? Yes, but it's also necessary. For her case, these are residents who are paying for this service, and while in the moment they are upset that she lingers while they take their meds, it's the service they pay for.
Basically, yes. All med techs at her job always deliver then watch the resident take the meds. The only time this isn't the case is if the residents care plan specifically mentions it's okay for the resident to take their own {labelled medicine} by leaving it with them.
Of her 80 residents that amounts to be about 3 people who she is able to just leave the meds for. This is because these are people who are in assisted living for physical problems, not mental decline. It's not always that these people do or don't know better, it's that they may just not be in a place mentally to do it for themselves, even if they have moments or even are mostly lucid.
I'd say it's more from the perspective of these people are paying for that service and it's not so much their own lack of autonomy but your provided care.

You say nursing is only a job to you and not a calling, and yet here you are taking on career risk to yourself just so you can respect the autonomy of a patient whose autonomy is being disrespected by everyone else.
I love you for existing. As an adult, I would feel far safer under your care knowing that you would treat me as an adult.
Because as everyone knows, the actively harmful version of this “treating adults as children” philosophy in medical care is when they don’t believe what you’re saying, claiming you’re trying to get attention.
What you’re fighting against is simple indignity. But the side effect of your fight is that people are protected from medical negligence as well.
Thank you so much. I won’t blame you either way, but I will love you dearly if you continue to take personal risks for the well-being of your patients.

Well, while the patient's bill of rights isn't exactly a universal law, the fact that you said the patient is a competent adult makes the rest of the post unnecessary.
Now, you may or may not be required to document patient compliance with care, that is a different issue. If you are required to do that, then you follow facility procedures.
But from the rest of what you said, you're allowed, per facility standards, to document you giving the patient the meds. That means anyone else can pound sand. And, if I was the patient, the blast of shit they'd catch for trying to force you to treat me like some kind of idiot might be entertaining.
A legally competent patient doesn't need to have their med compliance observed because that's their fucking right. Now, I get it, if the patient isn't compliant with treatment, the doctor/s would need to know. But, unless there's reason to believe that, why should you be treating the patient like an idiot?
Patient autonomy trumps damn near anything else, including facility policy, though they may well have to fuck right off to another facility if they're refusing care.
Stand your ground because advocating for your patient is the greater good here.

To me, I'd say that should depend on who is paying for the medicine. The person who carries that burden gets to complain about its fate.

15 comments