Cooooeee. Please may I pick your brains about supervising patients who are struggling to comply with taking their meds in in-patient facilities?

[Loveneverfails]

for whatever really, either their ill health or choice.

Basically....... I am a student mental health nurse who is dog tired and dreadfully hormonal today but I shall put that aside for now and I have to do a quality improvement project on this current placement freaking myself out at this point even mentioning it to you all

Anyway, I am currently on a locked ward, where there are a few patients who really struggle to comply with taking their meds. Staff are meant to supervise these patients (for ten mins) after the drugs are administered and then sign a small form to say that this has been done.

The thing is.... some of the patients blood results indicate that they are still defaulting from the meds they are required to take under their section .

So something is going wrong somewhere.

Still with me? if so

At this point, I am trying to find out what good practice dictates monitoring SHOULD LOOK LIKE from the nurses perspective?

Cannot find a local policy OR anything from the NMC even

My charge nurse, indicated supervision should be direct and for 30 mins post-drug administration (for every round). I have been asked to draft a document for tomorrow of what 'I think' sufficient patient monitoring should look like and I wanted to bring some research into it! But I am struggling to find any maybe I am thick after all

Thanks in advance for any help off to do more lit searches I go, hate the blardy things

[Lilybensmum1]

That's a toughie! I'm an RN adult branch, if the NMC have no guidance it's a bit worrying. For me in practice I am supposed to watch each of my patients take their drugs and then sign. Luckily as I'm in adult nurse not mental health I can trust my patients to take their meds with minimal supervision.

However we of course have MH patients think dementia, when this is the case I have to stay and cajole these patients, it takes time, a lot of time. If I cannot get them to take meds I clearly mark it on the drug chart and let those who need to know, know.

I know mental health is difficult especially if you are dealing with patients who lack capacity or who are sectioned, what does your mentor say? Have you tried speaking to the RCN? If you are a member. Practice and guidelines don't always relate do they?

[Lilybensmum1]

Surely the trust you are placed at has a drug administration policy, Also the NMC are explicit in what they expect from drug administration, it's just a case of applying it, I know the NMC guidelines are blanket but, they apply and if your/other nurse practice is falling outside of this then they are breaching the code.

I know practice is not perfect but you have to make it fit, it is so much easier as a qualified nurse as you are more autonomous and can question practice. Good luck.

[scousadelic]

I'm not in MH but my role overlaps somewhat with care of the elderly. I know that care homes for dementia patients can sometimes use covert administration if the patient lacks capacity and it is in their best interests. CQC regulate them and some private MH units so might there be any information in CQC guidelines that would help?

[TheSilveryPussycat]

The 4 times I've be in with hypomania, I have begun by refusing medicine - and then not taken the pill, hiding it under my tongue, etc. But only at the very beginning, on admission! Remember, I don't know what's going on, exactly, or whether I can trust people. Usually one HCP has somehow gained my trust, and then I'm compliant. And anti-psychotics work very quickly on me, so I get to a better state after a day or so.

Then, as I've been doing with my psych on the outside, I try to co-manage my meds with the staff - not an approach which seems to happen much on the inside, I suppose for good reason! Although I did manage to negotiate a couple of nights without quetiapine (which was giving me nightmares, but that didn't seem to be taken into account) and still had to be persuaded to take anything to calm my agitation.

I don't suppose this is much use for your purposes, except in so far as it points up the need for trust to be built, and the patient's view to be taken into account, at least.

[Lilybensmum1]

As thesilverypussycat says, it's about gaining trust and compliance to give meds otherwise, you are acting outside of NMC guidance. Covert administration is never ok as far as my professional knowledge knows?? I think it used to be ok now definatley not but I'm sure you know that.

If you can't get the person to take the drug DOCUMENT then inform thosr who need to know. Although you would love to get everyone to comply it's not always possible so, either they are sectioned and then it's slightly different or you need to ensure you protect your registration and PIN by acting professionally and reporting to superiors.

[dontrunwithscissors]

Am I missing something here? Presumably these people are either hiding the medication in their mouth and then spitting it out, or making themselves sick afterwards. How else would they be able to take their meds in front of someone and then dispose of them? When I've been in, people known/suspected of doing this have had their mouths/cheeks/tongue straight afterwards and then monitored long enough that being sick isn't going to bring up the tablets. I suppose the length of time would depend on how long it takes for medication to be absorbed.

[PlentyOfPubeGardens]

When I worked on secure wards (many years ago) a lot of patients were prescribed syrup versions of their meds so they couldn't hide it under their tongues.

[dontrunwithscissors]

Sorry should have read they had their mouth/tongue/cheek checked straight after they've taken the meds.

[SnowyMouse]

When I was inpatient they used liquid and orodispersable.

[TheSilveryPussycat]

I meant to point out more explicitly that, given the psychotic premises under which my world-view was operating, it is perfectly reasonable, nay advisable, not to take pills that someone you don't know is urging you to take. Hence the need for trust.

[mrssmith79]

Holism. Get to know your patient - their fears, questions, suspicions. Treat them as individuals and not subjects to be monitored (not a criticism, just an observation from practice). Empowerment too. Provide them with info on their meds and allow them to make choices. MH inpatient wards are hugely 'doctor knows best'. Have a look at the detriments of paternalistic practice. Look at the mental capacity act regarding decision making. Have a look at the relevant NICE guidelines. If all else fails, whack 'em all on depots . Nb. I in NO WAY advocate this

[mrssmith79]

Just a thought OP. The sectioned patients who are non concordant. Are they being assessed by a SOAD after 3 months as per MHA requirements?
What you're looking into is hugely interesting stuff and I can't help but feel that the 30 mins direct supervision post-round would either require a lot of staff for 1:1 or a group monitoring approach which smacks of institutional practice - a huge no-no...
Good luck

[scousadelic]

Lilybensmum Just for clarity, I wasn't suggesting covert admin is ok in this situation but that CQC guidelines might have guidance for situations where administration is difficult

[binspin]

Have you looked at past care plans to see how it has been dealt with in the past?

[Loveneverfails]

thanks guys

will take on board all youre saying.

Man I wish I only had placement to concentrate on and not this big project toomy PMT isnt helping is it?