dispensing meds???

[travel50]

When a skilled resident goes home, we do not send their meds with them. We keep them to be destroyed. (I think that is ridiculous). I get a new patient in at 7PM on a Saturday nite. I will not get their meds from the company pharmacy until Tuesday around noon. That is b/c our pharmacy closes at 6 pm and does not work on Sunday (I know that no one needs meds on the Lord's day). I can't get the orders to our pharmacy until Monday. They don't deliver Monday b/c they got no orders on Sunday. So they will come on Tuesday. The local back up pharmacy is only open till noon on Saturday, and they seem to agree that people do not need meds on Sunday, so they don't open until 9ish on Monday morning. Now I refer back to the skilled resident who went home. Add that to the 10 other ones who left. (We do alot of rehab). Between all those dc'd residents' meds, I have all the meds I need for the new resident. But if I use those to give to the new resident it is illegal b/c I am dispensing meds????!!! So the resident is just supposed to do without? My boss said to call the doctor and get a substitute that we have in the ekit. Great idea, but there is just not much to substitute for lovenox (coumadin was ineffective), or 360 mg of lasix a day (the ekit only has 240 mg total), or SL morphine when someone has pain from bone cancer (a previous resident went home with hospice). Furthermore, my boss says that giving meds (untouched and undammaged) that had belonged to another person (meds just waiting to be destroyed) is dispensing meds b/c they were not specifically labeled for the new patient. But the meds from the ekit are not specifically labeled for the new patient either, so isn't that dispensing meds also?????

And the above comment about the Lord's day is not antireligious. Please don't think that. It is just hard for me when I need meds on Sunday and can't get them.

[CapeCodMermaid, RN]

Why don't you send the residents home with the meds you ordered for them? I'd much rather know they had enough medication when they get home. We send narcotics as well if we have a specific order. And, no disrespect meant, but your pharmacy needs to get a clue. We are a 24 hour a day, 7 day a week business and so are they Lord's day or not.

[travel50]

When the residents are skilled, we pay for the medicines. Therefore, the corporate office tells me I cannot send them home with them. None of them. Not even if they go home Saturday at 1pm, with me knowing the pharmacies don't open until Monday morning at 8:30. If they are medicaid or private pay, I am to send their meds with them. So these meds for the skilled residents who have left just pile up until I destroy them. They can be in a bubble pack, untouched, good for 2 more yrs, but I am to destroy them. I am told that if I send them home with them, then I am dispensing meds and could lose my license. I don't understand why it is not dispensing meds if they are medicaid, but is if they are medicare.

Well, I don't mean any disrespect either, but people get sick 7 days a week. I know we live in a rural area, but still it poses a hardship on us for the pharmacy to be closed after 6pm and then from noon Saturday till Monday morning. I mean, even gas stations are open 7 days a week.

[CapeCodMermaid, RN]

Tell your corporate people that who pays for the meds makes no difference. If you have an MD order and the meds are labeled with the resident's name and directions it it not dispensing.

[caliotter3]

Since they have two sets of rules based on medicaid versus medicare, and these rules have nothing to do with the question on hand (medication for resident); I would look at it this way: You said the facility pays for the meds. That makes the leftovers part of the "house stock". Use them on Sundays. Saves money for the facility and the resident does not have to go without medicine.

[debRN0417]

The medications that are not used should be credited- I am not very insurance savvy, but I think that even if the facility "pays" for the medications, they have to be returned and there is some kind of credit there. In our state Narcotics cannot be returned, and have to be destroyed at the facilty by the DON and pharmacist- which I think is a total waste. I agree that if the medications are ordered for the resident they should be allowed to take them upon discharge because technically their insurance has already paid for them...they just have to be in a container and labled or something with the number and directions etc in order for them to be legal and so that no one gets sued over someone not knowing what meds they had and how to take them...

I can relate to your delimma but indeed if you give some of those medicines to another resident that are labeled for the other resident then it is against the law- prescriptions cannot be transferred...

It is unbelieveable how many times medications are not available for residents because of the pharmacy not delivering or whatever...

[CapeCodMermaid, RN]

Unfortunately in Massachusetts, there are only a very few meds we can return for credit and only for MassHealth (Medicaid) residents. Narcotics can never be sent back. I send an email to the governor every other month about the waste of money it is. A few years ago we'd give the 'leftover' meds to the nurse practitioner and she'd bring them to the homeless shelter or one of the local clinics.

[achot chavi]

Yeah, cant return meds, pharmacy is not allowed to take em

Yeah people need meds 7 days a week, but it sounds like ur not gonna win this battle

Only solution is to tell the doc he can only order meds (when the pharmacy is closed) that are available in your ekit,

you cant dispense what you dont have, so he is limited to what is available until tuesday...doctors problem not yours and it wont pay to get all upset about it,,,remember the serenity prayer.

You have to work within the system and so does the doctor, so if you get an admit when the pharmacy is closed (whatever the reason) inform or remind the doc that he cant order meds unless they are in the ekit and if he has a problem with that, have him chat with your Administrator to work it out.

Stay calm about this.

[achot chavi]

Unfortunately in Massachusetts, there are only a very few meds we can return for credit and only for MassHealth (Medicaid) residents. Narcotics can never be sent back. I send an email to the governor every other month about the waste of money it is. A few years ago we'd give the 'leftover' meds to the nurse practitioner and she'd bring them to the homeless shelter or one of the local clinics.

That has legal responsibilities as well, If I were you, I;d throw em out in a clean bag, whoever takes the clean bag from the wastebasket, well thats their responsibility, and they can do with it as they want as you didn't "give" it to the, but the nurse practitioner should be aware that she might have legal problems by dispensing your leftovers....

[CapeCodMermaid, RN]

We no longer give them to anyone. I have to pop them out of the the package into a container of really hot water. When they have mostly dissolved I add old coffee grounds (cat litter works, too) and they go out with the regular trash. We no longer flush them because so many remnants have been found in the water supply.

[debRN0417]

Yeah, we have flushed so many drugs, they are showing up in our water...see this just goes to show there should be some way to take these drugs back and use them. How many people in the world, or just in our communities have need for these meds we throw away...we are such a wasteful country. I wonder what they do in other countries?

[travel50]

Thanks everyone for your responses to my question. And I am trying not to stress over it. Just had so much going on this week that that was the straw that broke the camel's back as they say. To answer a couple of points, the meds in question had belonged to a skilled resident which means their insurance did not pay for them, the facility did. Therefore the facility is not allowed to send them home b/c that is "dispensing meds". I just don't understand why it is not "dispensing meds" when we send them home with a resident who was medicaid. And the pharmacy will not take the meds back, even if none of the med has been used. I think pharmacists must have alot of lobbyists working for them!