Risk Management Considerations When Patients Are Noncompliant With Medications
Addressing and documenting patients’ failure to comply with their medication regimen ensures you are providing the best care and protects you if an adverse event should occur.
Over the course of your career, you will treat a patient who is noncompliant with prescribed medications. This can include a patient who stops prescribed medications without discussion with you, is taking too much, is taking medications sporadically, is refusing to take a medication that is indicated, or is using street drugs in addition to the prescribed medication. These issues can occur throughout treatment or at points over the course of treatment. You may ask yourself, How can I proceed with treatment or can I continue treatment?
When treating a patient who is noncompliant with medications, you need to take into account a number of considerations. Among them:
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Address the issue with the patient. It is important to discuss the noncompliance with the patient and document the discussion in the medical record. Documentation is critical, particularly in the event of an adverse event.
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Ensure that noncompliance is documented objectively, not subjectively. Documentation is used to reconstruct the care provided and should be an accurate, objective reflection of care provided to the patient. For example, when documenting a patient’s noncompliance, rather than documenting “Pt is noncompliant,” you should write an objective, specific description, such as “Pt indicates he is taking his Zyprexa 3 out of 7 days/week. Pt advised to take Zyprexa as prescribed.”
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Can you safely continue treating the patient? Or is the clinical risk of harm increased such that termination is indicated? If terminating care, be sure to know the regulations within your state and requirements for termination in order to minimize risk for a patient-abandonment claim.
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Does the patient lack the capacity to provide informed consent and does the patient require a substitute decision maker? Patients have the ability to decide to take medications or not. However, it is important to determine if the patient has the capacity to consent to treatment and, if you have concerns, to obtain advice on how to proceed with treatment.
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When indicated, consider involving family members. First and foremost, ensure that you have the patient’s signed, written consent to communicate with the family member. However, you may receive a call from a family member who wants to report the issue. You do not need consent to listen to the information the person reports; however, it is important not to discuss patient care issues or the patient with the family member absent consent.
It may be challenging to treat a noncompliant patient. Ensure that you address issues with the patient and that your documentation captures the issues in an objective manner. If you have questions on how to proceed and whether you should continue treating the patient, it is important to consult with your risk management professional or attorney. ■
This information is provided as a risk management resource and should not be construed as legal, technical, or clinical advice. This information may refer to specific local regulatory or legal issues that may not be relevant to you. Consult your professional advisors or legal counsel for guidance on issues specific to you. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, AG (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World.
Biographies
Kristen Lambert, Esq., M.S.W., L.I.C.S.W., C.P.H.R.M., is vice president of the Psychiatric and Professional Liability Risk Management Group of AWAC Services Company, a member company of Allied World.
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Published online: 2 October 2017
Published in print: September 16, 2017 – October 6, 2017
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