Medication Refusal: Resident Rights, Administration Dilemma

Abstract

Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

How do we provide good mealtime care for people with dementia living in care homes? A systematic review of carer–resident interactions

“…At a broader level, the idea of refusal of/resistance to a care act of some kind – and the way in which staff respond to this challenge – is well documented in the dementia care literature. There are examples in the context of medication ( Haskins & Wick, 2017 ; Young & Unger, 2016 ), oral hygiene ( Jablonski, et al, 2011 ) and general care ( Konno, et al, 2012 ; Mahoney et al, 1999 ). It is not clear why there is a relative absence of this theme in mealtime care literature.…”

“…There are examples in the context of medication (Haskins & Wick, 2017;Young & Unger, 2016), oral hygiene (Jablonski, et al, 2011) and general care (Konno, et al, 2012;Mahoney et al, 1999). It is not clear why there is a relative absence of this theme in mealtime care literature.…”

Public awareness and knowledge of factors associated with dementia in China

“…This may be explained by the fact that the publicity of disease prevention mainly focuses on lifestyle elements [31,32], thus neglecting the fact that chronic diseases, including hypertension and diabetes, are risk factors for dementia [17]. Moreover, medication refusal is common in the general population [33], and people are often more concerned about the side effects of antihypertensive and hypolipidemic drugs than their beneficial effects [34]. Other studies also found that people had less knowledge about the role of cardiovascular disease management in the development of dementia [21,35].…”

Administration of pro re nata medications by the nurse to incapacitated patients: An ethical perspective

“…43 If it is not resolved by the healthcare team, an ethical dilemma may occur given its impact on the patient's care outcome. 65 As if it is not a perfect solution, the use of clinical guidelines and a three-step approach of the physician, ethics committee, and guardian have been suggested. 64 The essential legislative core for all European member states to guarantee the protection of human rights regarding biology, medicine and healthcare is the ‘Convention for the Protection of Human Rights and Dignity of the Human Being about the Application of Biology and Medicine’ 66 and its additional protocol.…”