Supporting A Patient Refusing To Take Their Medication

“Above all, good communication, information, patience and empathy is the best way to support a Patient refusing medication!”

Administering medication brings with it a host of challenges, especially if a Patient is being uncooperative. Plaxedes gives some tips on how to support those refusing to take their medication.

Topics Covered In This Article

Introduction

Why Do Patients Sometimes Refuse Medication?

What Forms Of Medication Are Commonly Prescribed?

Who Administers Medication In Inpatients Units And What Specific Skills Are Required?

Which Other Professionals Can Be Involved?

What Steps Do Nurses Take To Support A Patient Refusing Medications?

What Are The Challenges Of Patients Refusing Medication?

What Skills Do Nurses Require To Support A Patient Refusing Medication?

What Is The Role Of The Nurse In Supporting A Patient Refusing Medication?

Final Thoughts

Introduction

Often, Nurses on the Wards have to support Patients not willing to take medication for different reasons.

This could be oral, or intramuscular injections.

Whilst this might be seen as time-consuming, it is important to gain Patient co-operation to ensure concordance and a swift recovery, leading to a shorter hospital stay.

Why Do Patients Sometimes Refuse Medication?

Patients can refuse medication for various reasons.

This could be the taste, colour or smell of some liquid medication.

Patients may also refuse medications which are in injection form because of pain on injection sites, or they might have had a negative experience with staff, or the medication before.

At times, Patients refuse medication because of the side effects or likely negative experiences.

Some Patients already have some knowledge about certain medication.

What Forms Of Medication Are Commonly Prescribed?

Medication can come in different forms.

These include tablets in powder and capsule form, Liquid, Suspensions, Nasal Sprays, Topical, Sublingual or Lozenges, Patches and Injections, the latter of which can often be painful.

Who Administers Medication In Inpatients Units And What Specific Skills Are Required?

Registered Nurses who are specially trained and completed their competencies are responsible for administering medication.

Good communication skills play a very important role.

In mental health settings, medication can be a challenge at times due to the mental state of Patients and requires a great deal of tact and patience.

Nurses have to work very closely and with a clear care plan which is easy to follow, with objectives of offering medication clearly written.

Which Other Professionals Can Be Involved?

Doctors and Pharmacists can be involved.

In mental health units, any healthcare staff with experience in working with people with severe mental illness can support by jointly encouraging the Patient to take medication, if that is the appropriate course of action.

What Steps Do Nurses Take To Support A Patient Refusing Medications?

It is very important for Nursing staff to prepare to approach the Patient refusing medication.

The Nurse should explore the Patient’s concerns and reassure them.

The Nurse should explain what the medication is, what it is indicated or prescribed for and the side effects and possible side effects.

The Nurse should assure the Patient that they can have their medication at an agreed time.

However, it also depends on the urgency and sometimes has to be taken according to prescription guidelines.

The Nurse must assure the Patient that they are able to liaise with the Pharmacist and Doctor should a different form be required.

The Nurse can also offer the Patient a Medication Patient Information Leaflet and Medicines Information Sheet provided by the local Trust Medicines Management Department prior to administering medication.

What Are The Challenges Of Patients Refusing Medication?

Challenges may include the Patient's health not improving swiftly, prescriptions might have to be changed and some medicines are expensive.

Moreover, the Nurse-Patient relationship might also be compromised due mistrust.

What Skills Do Nurses Require To Support A Patient Refusing Medication?

The Qualified Nurse has to adhere to NMC Guidance and Standards when administering medication at all times.

Medication should not be crushed for the Patient to take.

The Nurse should therefore liaise with the Doctor or Pharmacist for an alternative form to be prescribed.

What Is The Role Of The Nurse In Supporting A Patient Refusing Medication?

The Nurse must consider a number of issues in supporting the Patient.

It could be Patient is not feeling too well which might need further investigation or they have swallowing reflex problems.

Some may request more water, or a drink with their medicine.

The Nurse should encourage the Patient to take the tablets with a little water first then offered a juice of their choice unless contraindicated.

Extra care should be taken with the Elderly and frail Patients, who may require more time to take their Medication.

Also, some injections might be too painful hence sizes of the needles also have to be checked.

The Nurse has to show empathy and also explain to the Patient that it is in their best interest that they take medication, so they can get better and be discharged home after a stay in hospital.

In mental health inpatients units, the RMN must consider the Patient’s mental state, mood and the legal Frameworks or Mental Health Legislation on Consent to Treatment in line with the Mental Health Act 1983(revised 2003).

The Nurse must also be aware of the Mental Capacity Act (2005), or the 3-month rule, which allows that Patient can be treated if acutely unwell to give consent for their treatment.

Efforts for full explanation about the medication should be offered.

At times, some medications may have to be offered when the Patient's mental state starts improving.

Sometimes in mental health settings, some injections have to be administered under physical restraint with support from other units.

The Patient has to be notified in advance of the plan and occasionally they might not mind and agree to be injected by the Ward staff they are familiar with, without any problems.

In some instances, unqualified staff with experience in working in mental health settings may be requested to assist with encouraging the Patient in the presence of a qualified Nurse.

There is guidance on Restrictive Practice and avoid physical restrain where possible where every effort has to be made to try and encourage the Patient to take their medication.

Final Thoughts

The Nurse should also offer positive feedback after the Patient has taken their medication and if they had made some request prior to medication administration, this should be facilitated for them.

This could be a phone call, or simply going out for fresh air!

Medication should never be forced on Patients as this might result in injury or chocking incidents.

Above all, good communication, information, patience, and empathy are the best way to support a Patient refusing medication!