Disposing of medications at time of death

[RubyRN,CHPN]

I was approached this week by a former colleague with a question. I thought I'd throw it to the experts:

Is it becoming common at time of death for hospice nurse to release unused narcotics to funeral home/director to give to coroner's office for disposal? Have you seen this done at your hospice or know of a hospice where this is being done? What is your policy?

[MassED, BSN, RN]

hi

the procedure we follow is that any opioid we have had prescribed for the patient while under our care is disposed at the time of death.

we have a family member observe us counting and flushing the opioids then signing the appropriate med disposal form.

personally i would be very uncomfortable signing over unused opioids to funeral home or coroner's office to dispose of.

for me i wanna see those suckers circling the drain lol :chuckle

giving narcotics to anyone that is not the patient is just insane. i can just imagine a funeral home representative saying "i need the narcotics..." what reason could they possibly give that wouldn't make them look like they want their drugs??? to bury them with them?? i have heard that flushing the medications at the residence when pronouncing a patient is common practice.

[czyja, MSN, RN]

That is what bugs the heck out of me. The hospices in Africa have to charge their patients (most of whom have next to nothing) for morphine (if they can even get what they need) and here we are dumping it out right and left. It is SO WRONG.

Drives me nuts too. The NY Times did a big piece on pain management in Africa a few months ago - what an eye opener. They reported that a combination of expense and heavy handed narcotics laws make it difficult to get even a Tylenol 3 for a pt with end stage cancer.

If I ruled the world I would pay the poppy farmers in Afganistan top $ for their crop and send the morphine to folks in Africa that need it. The fact that people die in pain when we have a safe and cheap way to make them comfortable makes me want to pull the few remaining hairs on my head out.

[koalalu]

Very true and that is a valid concern... Just wonder how else we could safely destroy opioids where no roaming fingers could help themselves!!

Hi,

Am new to the site and welcome all the great feedbacks I have been reading. I can tell you from my experience that I take a "clean" diaper (and you would be surprised why I say clean..LOL.) and drain the liquid Morphine and Haldol in the diaper to be absorb before throwing out. I also disolve the pills with hot water and also pour them in the diaper. I have had in the past a blow out among a husband and son regarding disposal. The property had a septic tank so the father refused to have things flushed and the son refused to have the liquids poured on the lawn for the animals to eat. I have found this method to be the most efficient and the families are very appreciative.

[leslie :-D]

Hi,

Am new to the site and welcome all the great feedbacks I have been reading. I can tell you from my experience that I take a "clean" diaper (and you would be surprised why I say clean..LOL.) and drain the liquid Morphine and Haldol in the diaper to be absorb before throwing out. I also disolve the pills with hot water and also pour them in the diaper. I have had in the past a blow out among a husband and son regarding disposal. The property had a septic tank so the father refused to have things flushed and the son refused to have the liquids poured on the lawn for the animals to eat. I have found this method to be the most efficient and the families are very appreciative.

that sounds like a wonderful idea!!

leslie

[hospicemom]

great idea!!!!!!!!!!!!

[saribeth]

well get a load of what we do...our manager heard about this at a reginal meeting...plastic zip lock bags with kitty litter...dump the liquids, pills etc and patches (opened and folded in half) and buried deep in the trash with a prayer:saint: almost everyone has a zip lock type bag and if I don't have the litter with me I use paper towels to soak it up!!!!!!!

[amyindiana]

I have worked for several hospices, I have never heard of this practice. I feel it would be a liability to the hospice as these drugs are provided under their direction.

[curiousauntie]

When I worked in long term care, we used to joke about the happy fishies...after flushing the narcs. Then when Medicare Part D happened and we had to start to dispose of all of the OTHER meds, because any one that had been paid for by a Medicare Part D program could not be returned to the pharmacy, we started to see how our tax dollars were being wasted over and over again.

Now in hospice, I used to melt them in hot water, in a glass or ceramic cup and flush them. But living near the ocean and all of the news about the antidepressants in the water supply has stopped that. Now we are supposed to use clumping kitty litter and a zip lock baggie...put the meds in and add warm water, squish around til it becomes a big mess, then throw in the trash. Yucky, but effective.

[amyindiana]

How do you have access to kitty litter in every home. Surely not every patient owns a cat?!?!? DO you carry kitty litter in your car?

[curiousauntie]

How do you have access to kitty litter in every home. Surely not every patient owns a cat?!?!? DO you carry kitty litter in your car?

Our policy says that we should have clumping kitty litter in zip lock bags available in the office...You see that in my original post I say that we are supposed to use kitty litter. I haven't gotten my bags yet, but there is always hope! The idea was that we would get a big bag of the stuff and our teen aged volunteers would put it in zip lock bags for the nurses. And yes, we would then carry it in our cars with the rest of the "death pac".

[dailysong]

Our facility's protocol is to pour liquid meds into cat litter. Suppositories are crushed or microwaved and pour into the litter. Pills are also crushed and water added, etc. etc. The litter is then thrown away. While it's still a possible concern with contamination, it seems this would be less likely a direct hit on the water.

Tough item wish we could donate to veterinarian's offices or Humane Society Medical Professionals.

[AtlantaRN, RN]

crush medications and put them in with coffee grounds, rather than flushing them and contaminating the water system.