Failure to Honor Resident's Right to Refuse Medication
Penalty
Summary
A resident with severe cognitive impairment, vascular dementia, psychosis, and major depressive disorder was observed to have her right to refuse medication violated. The resident's care plan acknowledged her history of refusing medications and outlined interventions such as explaining procedures, allowing time for adjustment, and leaving and returning later if care was resisted. Despite these interventions, staff did not honor the resident's repeated verbal refusals of medication. On the day of the incident, the resident was being assisted by two CNAs when an LPN attempted to administer her medication. The resident spit out the medication twice when offered on a spoon. The LPN then left the room, returned with a syringe, and administered the medication by holding the resident's nose and mouth closed until she swallowed, despite the resident verbally expressing refusal. Both CNAs present witnessed the event and reported that the resident was saying, "I don't want it, I don't want it," during the process. The LPN admitted to using this method to ensure the resident took her medication, stating it was not done maliciously and referencing the resident's history of being combative when not medicated. The facility's policy and the Director of Nursing confirmed that residents have the right to refuse medications and that such rights must be honored, especially for those with cognitive impairments. The incident was also documented in a psychiatric note, which confirmed the nurse's actions and the resident's difficulty with communication due to expressive aphasia.