Noncompliance

Published on Saturday March 10th , 2007

Noncompliance

(_) Exercise (_) Follow-up Care (_) Medication (_) Other

**Related To:**
*[Check those that apply]*
(_) Chronic illness (_) Fatigue (_) Depression (_) Non supportive family (_) Inadequate/incomplete instructions (_) Denial of Dx	(_) Side effects of therapy/med (_) Impaired ability to perform tasks (_) Expensive therapy (_) Other:_____________________________ ____________________________________ ____________________________________

**As evidenced by:**
*[Check those that apply]*
Major: (Must be present)	(_) Verbalization of non-compliance or non-participation or confusion about thrapy and/or (_) Direct observation of behavior indicating non-compliance
Minor: (May be present)	(_) Missed appointments (_) Partially used or unused medications (_) Progression of disease process. (_) Persistance of symptoms

Date &
Sign.

Plan and Outcome
[Check those that apply]

Target
Date:

Nursing Interventions
[Check those that apply]

Date
Achieved:

The patient will:

(_) Demonstrate compliance with:

(_) Other:

(_) Assess patient's:

Understanding of disease process
Barriers to compliance
Life-style
Support system
Perception of non-compliance
Other:

(_) Allow patient and s/o to verbalize feelings about situation/

(_) Adapt regime to patient's level of comprehension.

(_) Involve patient - s/o in planning compliance.

(_) Emphasize positive aspects of compliance.

(_) Instruct patient - s/o about meds:

Side effects
Dosage
Other:

(_) Set goals with patient.

(_) Consult with:

PT
OT
Home Health
Social Services

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

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