It is the client’s right to refuse medications. Individuals should understand the symptoms that medications are prescribed for, and also should be made aware of any common side effects. He/she should also be able to verbalize understanding that these medications are considered a part of treatment and that the Licensed Practitioner will be notified should he/she refuse the medication

 

        1.      When the client refuses medication:

• The client always has the right to refuse medications.
• Clients refuse to take medications for many reasons. Some of the reasons are;
• The effects and/or side effects are unpleasant or unwanted;
• The medication tastes bad;
• The client has difficulty swallowing;
• Religious, cultural, or ethnic beliefs;
• Depression or loss of will to live;
• Delusional belief that staff is intending to harm (“poison”) him/her.

 

        2.      B. Types of refusal

• Actual refusal is when a person directly refuses to take the medication;
• Passive refusal is less direct and requires closer observation.

 

Example is:

The client takes the medication but later spits the medication out; he/she may or may not attempt to hide the medication.

        3.      C. Questions to ask to try to determine the reason for refusal:

 

• Does the client experience any unpleasant effect from the medication?
• Does the client have difficulty swallowing?
• Is the client afraid for some reason?
• Is the client refusing other medical treatment?

 

        4.      D. Examples of Strategies for dealing with client’s refusal:

•  If the client refuses and gives no reason, wait a few minutes and then offer the medication again. If the client refuses again, try again in another few minutes before considering a final refusal. This is particularly important for clients who have a diagnosis of dementia.

             NOTE For clients with cognitive impairment such as dementia, it is important to know when the client designee, such as a responsible party or guardian, wants to be notified if the client refuses medication. The client designee may be able to encourage the client to take the medication.

• Notify the prescribing practitioner or supervisor when a client refuses medication;
• Document refusal;
• Observe the client and report any effect which may result from refusal;
• If there is swallowing difficulty, report to your supervisor and/or client’s physician;
• Consider changing the time of administration if taking the drug interferes with an activity or with sleep. (Example: diuretics may limit a client’s ability to participate in an outing because of the need to go to the bathroom frequently.);
• If there is a suspicion of passive refusal such as “cheeking” medication, follow the recommendations for action on the client’s Individualized Care Plan;
• If the refusals continue, explore other options with the client’s physician.

NOTE: Passive refusal is not uncommon in clients with diagnoses of mental illness. It is important that the client or client designee, facility staff, nurse, pharmacist, and physician collaborate to develop and follow a plan to assist the client with adherence to his/her drug regimen.