Wondering what everyone's thoughts are re: this scenario...patient is being discharged, physician writes an order for patient to be discharged with a dose of whatever opioid they were on (p.o.)--for example, "discharge patient with 1800 dose of 30mg p.o. morphine".
I refuse to do this, as if that opioid gets into the wrong hands, or is taken a different route, for example (I could think of many possible scenarios), isn't my license on the line?
The difference there is that meds given in an LTC have often already been dispensed for that specific patient by a pharmacy, the LTC is then giving the patient meds from the patient's stock of meds, not the facility's stock of meds, this is technically assisting with self administration rather than administering. There's no problem sending these meds home with a patient because they were dispensed for the patient from the beginning.
In certain circumstances, we do the same when inpatient hospice patients are being transferred to their homes to continue hospice on our service. These are meds that have been dispensed from the pharmacy and not taken from the pyxis. If they revoke or are discharged from hospice, we do not send any meds from our pharmacy. We count meds being sent home and the responsible party signs the paper accepting the meds. Education is also provided and documented.
My point being is that there are specific circumstances where it may be appropriate to send patients home with meds, including controlled meds. This is where it is important to know facility policies, correct procedures and be aware of scope of practice/ legal issues pertaining to this.
Does anyone else ever feel like their brain gets too full some days trying to navigate all the different nuances that I never imaged would be a part of nursing????
The difference there is that meds given in an LTC have often already been dispensed for that specific patient by a pharmacy, the LTC is then giving the patient meds from the patient's stock of meds, not the facility's stock of meds, this is technically assisting with self administration rather than administering. There's no problem sending these meds home with a patient because they were dispensed for the patient from the beginning.
Exactly this and you put it much better than I did so thank you for that. Those meds are essentially that residents meds and we normally have a 30 day supply dispensed and available in our dispensing machine. A majority of our residents are elderly and on a fixed income so refilling those meds can be problematic depending on their insurance. Any supply we don't send home with them at discharge is credited back to their payer source, but that can be a somewhat slow process and in the meantime that resident could have to pay for any additional refills out of pocket. Our rounding providers are at least good about making sure all discharging residents are provided with current prescriptions for all meds including controlled meds so residents won't have any difficulty getting their meds filled once they leave other than the possible financial hit while waiting for the insurance reimbursement to go through.
vampiregirl, BSN, RN
824 Posts
In certain circumstances, we do the same when inpatient hospice patients are being transferred to their homes to continue hospice on our service. These are meds that have been dispensed from the pharmacy and not taken from the pyxis. If they revoke or are discharged from hospice, we do not send any meds from our pharmacy. We count meds being sent home and the responsible party signs the paper accepting the meds. Education is also provided and documented.
My point being is that there are specific circumstances where it may be appropriate to send patients home with meds, including controlled meds. This is where it is important to know facility policies, correct procedures and be aware of scope of practice/ legal issues pertaining to this.
Does anyone else ever feel like their brain gets too full some days trying to navigate all the different nuances that I never imaged would be a part of nursing????