Asklemmy

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

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.

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.