How should you handle a patient who refuses a medication offered under standing orders?

• A. Respect patient autonomy after providing information; document refusal; consider medical control for risk.
• B. Forcibly administer the medication.
• C. Ignore the refusal and proceed with administration.
• D. Contact the patient's family for permission.

Answer: (A)

Respecting the patient’s autonomy is essential when a medication is offered under standing orders. If the patient is competent, they have the right to refuse after receiving clear information about what the medication does, its benefits, and its risks. If the patient refuses, do not administer the medication.

The next steps are to document the refusal thoroughly in the chart, including what information you provided and how the patient articulated their decision, along with any assessment of their decision-making capacity. If there’s any concern about risk or if you’re unsure about capacity, contact medical control for guidance on how to proceed. Do not force administration, and do not seek permission from family members in place of the patient’s stated decision.