Narcotic meds "to go?"

[DallasRN]

Hello all! I have tons of hospital experience in almost every department you can think of. However, I'm as new as you can get to LTC skilled nursing. What a different world! I have a truckload of questions/concerns, but I'llstart with just one today.

When a resident goes out on pass, is it OK to send narcotic medications with them? Doses of things like antibiotics I can understand, but sending out Schedule II narcotics causes me great concern. What if person od's, has a reaction, sells the drug...I don't know. Just doesn't seem like safe practice to me. Liability issues? Then again, things are really different in this environment. In general, HELP - and all thoughts appreciated.

[bugya90, ASN, BSN, LVN, RN]

When I worked LTC if the patient was just going out on a short pass (ex:family taking them to lunch then coming back) we wouldn't send any narcs, we would medicate before they left facility if needed. If they were going out on pass for several hours or days even then family could sign out a small amount of regularly used narcs, normally just enough to get them by until they return (ambien, chronic pain meds,etc)

[LeChien, BSN, RN]

We had a special sheet where the family would "sign out" how many they were taking with them. We weren't allowed to withhold meds from a patient just because they are out on pass.

[Julius Seizure]

If they weren't in a LTC facility, they would have possession of their narcotic prescription. Once they sign it out, it's their responsibility, to me.

[CanadianAbroad]

The facilities I worked at, had the sheet to sign out. We would sign and they would co-sign in what meds they would get. Liability was released from me and onto the person responsible for the patient.

[verene, MSN]

When I worked in an LTC it depended on the situation. If the resident was going out for a couple of hours to a group activity or family lunch then we'd try to medicate around the schedual. If they would be gone for half-day or more then we'd send meds to-go with a list of dosage instructions, patient confirmed receipt of medications and instructions on a sign out sheet. Any meds not taken while out would need to be signed-in upon return.

[Neats, BSN]

Remember this SNF is a home of record, this means this is the person's home. If they are on sub-acute then this is different. If the resident is out for a few hours and will return I would ask the resident if they need medication prior to leaving, if they want to take it with them or if they would like it when they get back (make sure you have it ready), you are covered for survey then. If they want to take it with them I sign it out and have them initial the little note next to my name or I have another nurse co-sign the narc book/MAR (on the back of the MAR wherre comments go) and give the patient the packet as they are walking out the door with the co-sign nurse in observance. This way no one can come back and say I never received it.

Trust all, verify all.

These residents are adults and have their own life who am I to tell an 85 year old who can make their own decisions how to take their medications or for that matter what to eat, wear, when to go to bed...the most I can do is encourage and include a little teaching. Most will want their medication just prior to walking out the door and right upon returning to the facility. If they are gone overnight we make up packets, again have them sign or family. Dialysis patients do this daily, we make up packets of their routine medication they take it with them. I always put the medication packet in their lunch bag or shirt pocket, and document. Remember to put the date, name and medication name on the packet becuase it will be an F-Tag if you do not. I have had a family divert medication the niece would chew up the Oxy and my patient would be in such pain. Social services spoke with the patient, all was documented and elder abuse line called. This resident complained twice- after that I think she was in pain but did not want to get her niece in trouble. I also had a young resident sell her pain medication when visitors would come by-she was evicted.

[downsouthlaff, LPN]

LPN/LTC Nurse Here to offer my input and experience. At the nursing home in which I practice, the family/RP may sign a medication release form for the entire blister card of the narc. Two nurses must count with the R/P, sign and verify the count. When the resident returns the procedure must be repeated. When it comes to routine schedule meds such as Plavix, Carvedelol, ASA, Lipitor, etc etc it is acceptable for us to send pre dosed in pouches to ease admin. For the R/P. But the reason we allow the entire blister card of the narc to leave the facility is because an unidentified loose narcotic could constitute legal issues for the resident and R/P.