Reasons for meidcation refusal

Some reasons a person may not take medications as recommended may include:

• The person wants to avoid certain experiences of side effects (such as a bitter taste or uncomfortable sensation) or get certain “benefits” from side effects (such as feeling sleepy or high, or enjoying the taste).
• A conflict between lifestyle choices and medications requirements (such as sleep patterns, eating patterns, alcohol use, having to remember to carry the medications, having others know about medications)
• Confusion or lack of understanding about medications that may be caused by mental illness or cognitive disabilities.
• Confusion or lack of understanding due to language differences.
• Cultural and individual differences in understanding or valuing medications and treatments.
• Not believing there is a need for the medication.
• Not being able to afford the medication.
• Feeling the need for the medication in a dose larger than recommended (for example, taking 4 tablets for headache, rather than 2).
• Feeling so much better from a long-term medication that the person discontinues the medication (or wants to discontinue) too soon.

Responding to refusal to take medications

If possible find out why the medication is being refused and see if you can make a change. If the person cannot communicate directly this may require observation and trial and error. (For example, trying a different voice tone or touch during the procedure). If possible, ask for ideas from someone who knows the person well.  Do not give a second dose of medications that have been spit out.  It is impossible to tell what amount was swallowed or absorbed. Giving more of the medication may overdose the person.  Contact a medical professional about next steps.

If the person will not take the medication as recommended, follow procedures that are appropriate for the medication. For example, in some cases documenting the refusal may be enough. In other cases, a medical professional must be contacted immediately. You must know the medication, the person, and the consequences of missing the medication. If in doubt, seek advice from a supervisor, health professional or pharmacist.

In most cases, it will be important that you document exactly what happened. The details may be important in discovering why the person is refusing the medication.

People’s Rights With Regard to Medications

• People do have a right to refuse medications.
• Never try to sneak medications into food or drink.
• Never try to force someone to take medications against his or her will.

Involving People in Their Own Medications

Goals related to learning about medications will vary.  There are always benefits to reviewing medications as they are administered. This practice reduces the likelihood of errors. It keeps the direct support professional focused. For many people being supported, knowing what they are being given and why means they may be able to alert staff before an error is made.

Having people actively participate in preparing medications can be important too. There are many people being supported who have goals of more independent living. Learning about medications can be a very important part of meeting this goal.  Even for persons with severe intellectual disabilities, there are benefits. Being involved in medication administration can provide sensory and mobility experiences. It can provide opportunities to count, recognize shapes and colors, and to work on fine motor skills.

Teaching People About Their Own Medications

In order to teach effectively do the following:

• Find out what the person already knows and build on those skills.
• Find out what is most important to the person. Focus on what he or she wants to know.
• Be creative. Think of alternatives that might work for the person. If a person cannot tell time, can he or she learn to take medications when the 5 o'clock news comes on?
• Make it fun and pleasant, not a chore.
• If the learning is formal, track, document and reinforce (e.g., praise, recognition) successes and challenges.