Medication Compliance: Tips for Responding to Patient Refusal of Medication

• Medication compliance is vital for successful treatment, but how nurses respond when a patient refuses their medication is just as important. 
• It’s best practice to initially assume good intentions when a patient refuses medication. 
• There are several reasons a patient could decline a certain medication. Listen to their concerns before immediately documenting their resistance. 

Whether you are a brand-new nurse or an experienced nurse, nobody is exempt from experiencing patient refusal of medication. Some nurses navigate refusals very well. Others would rather avoid a potential confrontational situation. Before you rush to document, “Patient refused,” let’s discuss some reflections and conversations that may be helpful. 

Ask Why They Refused Medication Compliance 

While some patients enjoy making a nurse’s job difficult, there are a good number of patients who are just responding to the fear and discomfort associated with being in the hospital. Sometimes, it really is not personal.  

It’s best practice to initially assume good intentions when a patient refuses a medication. There is another factor to be mindful of before responding. Before you ask the patient why they don’t want to take the medication, take a moment to make sure your response does not reflect any negative thoughts you might have.  

What do I mean by that? Especially if it is a medication to treat potentially life-threatening conditions like hypertension, your first thought might be, “Are you crazy?! Why wouldn’t you want to take this medication? Do you want a stroke?  Do you see what your blood pressure is right now?”  

At that point, asking a simple question like, “Why don’t you want to take the medication?” may come across in a tone that conveys frustration and judgment. Take a moment to assume good intentions and seek a backstory. Then, repeat what you heard and express concern with empathy. For example, “I understand that you do not want to take this medication. What concerns do you have? What questions do you have for me?

This creates an environment for the patient to (hopefully) open up about why they’re refusing the medication.

Consider the Reasons for Lack of Medication Compliance

This list is not exhaustive, but includes several reasons patients might refuse treatment.  

• Patient Does Not Recognize the Medication: By asking with genuine curiosity about why a patient does not want to take a medication, you may find out that the patient does not recognize the medication. For instance, if you state the generic name of the medication, the patient may only know the brand name from taking it at home. Maybe the patient’s medication at home is a blue pill and you’re presenting a white pill. There may be a few possible outcomes from this conversation. You could discover a medication error. On the other hand, you might discover it’s not a medication error, but an opportunity to explain that this is the same home medication with a different color. 
• Lack of Understanding of Medication Indication: Teaching should always be infused in our conversations with patients. Before administering medications, be sure to communicate the name of the medication and the indication. It’s beneficial to gain a sense of what the patient does and does not know. We cannot assume they know everything. We also cannot assume they do not know everything. For this reason, you can make statements and ask questions such as, “This is your Lipitor. Do you know what this medication is used for?” or “This is your Lipitor to help with your cholesterol. Do you have any questions before you take your medications?” 
• Fear of Side Effects: Sometimes, patients may report that they do not want to take a medication because of how the medication makes them feel. At this point, you can express their concerns to the ordering provider to investigate if there may be alternative treatments or doses that can be explored. 
• Patient Doesn’t Believe the Medication is Effective: Sometimes, patients may not see or feel the results of a medication or treatment as quickly as they hoped. Many factors can cause a delay in effectiveness. The patient may be prescribed a time-release medication. In which case, education is key. Patient teaching and progress updates are essential. For instance, there’s nothing wrong with showing the patient your computer screen to see the vital signs trends. When patients express that they don’t believe that the medication is effective, do not ignore them. Patients know their bodies. There are times when a patient reports that the medication is ineffective, and it can spark an investigation into the reason. The nurse then becomes an advocate who can collaborate with the patient and the other members of the healthcare team to discuss adjustments to the treatment plan.  
• Patient is Resting: Let’s be honest. Hospital beds are not the most comfortable, and nobody wants to be woken up from their sleep. Consider whether or not the medication is something that can be rescheduled. If not, communicate empathy that you understand that they are tired and educate the patient about why it is important to take the medication. Involve their loved ones, if possible.  

Remember Why You’re a Nurse

Keep in mind that nursing is not just about medication administration. This perspective can relieve pressure by shifting our focus away from patient care that’ssolely order-driven and task-oriented. It is about a holistic approach to patient care that gives you permission to ask questions and become an advocate for your patient. Many times, newer nurses may feel that orders need to be adhered to when clinical judgement speaks otherwise.  

Patient care is not only an interdisciplinary collaboration, but also a collaboration between the healthcare team and the patient. The more the patient feels involved in their care and decision-making, the better the outcome. Healthcare is not a dictatorship where we tell patients what they should do. It is about educating about best practice and discussing options together to give the patient a chance to make an INFORMED decision.  

The Bottom Line

Patient refusal of medication is inevitable. However, taking a step back to understand the “why” and creating a safe space for the patient to express concerns can make a world of difference. While there is no guarantee that the patient will comply immediately (or at all), the outcomes of key reflections and conversations are invaluable. Opening the lines of communication and cultivating a culture of collaboration can potentially build trust and plant seeds for willingness to comply in the future. I wish you all the best!  

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