Discharging Patient With Opioid in Hand?

  1. Hello,

    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?

    Thoughts?
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    About ceegee69, BSN

    Joined: Feb '18; Posts: 2; Likes: 2

    25 Comments

  3. by   MunoRN
    Giving a patient a medication for them to self-administer typically falls under "dispensing". You could either administer the medication before they leave, or have it properly dispensed by the hospital pharmacy if they are able to do that, which means properly labelling and packaging it for self-administration.
  4. by   Double-Helix
    No way. If the patient wants their next dose of morphine before going home, they can hang out until 1800 and be discharged when it's swallowed.
  5. by   KelRN215
    Quote from MunoRN
    Giving a patient a medication for them to self-administer typically falls under "dispensing". You could either administer the medication before they leave, or have it properly dispensed by the hospital pharmacy if they are able to do that, which means properly labelling and packaging it for self-administration.
    This. Order or not, a nurse dispensing a dose of medication for the patient to take home with him is likely against hospital policy.

    Did we occasionally do it when I worked in the hospital? Yes, but in very rare circumstances like the pharmacy had already sent up the patient specific unit-dosed PO liquid zofran and the patient is discharging on the night shift to another state and has out-of-state Medicaid and the med requires a PA and the pharmacy will be closed by the time they get home and the hospital's free care pharmacy that exists exactly for this purpose is already closed. But NEVER with narcotics.

    The MD can write the patient a prescription for PO morphine and the patient can fill it at the pharmacy of his choice on his way home. Most pharmacies are open past 1800.
  6. by   Been there,done that
    This is now dispensing. Pharmacy must provide any meds that are ordered post- discharge.

    The doc needs a lesson.
  7. by   canoehead
    We do it all the time in the ER with full knowledge of the pharmacy. They get enough to make it through til their script can be filled.
  8. by   CharleeFoxtrot
    Quote from canoehead
    We do it all the time in the ER with full knowledge of the pharmacy. They get enough to make it through til their script can be filled.
    Yup, our local ER started doing this as well when the only 24 hour pharmacy in a 30 mile radius closed. I was grateful when my spouse have a hairline FX of his tibia and they sent us home with a couple of pills, enough to tide him over until I could get to the pharmacy at 0900am.
  9. by   JKL33
    Quote from ceegee69
    Hello,

    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?

    Thoughts?
    Agree with the others.

    Generally speaking pharmacy would prepare and dispense the dose and that is usually reserved for situations where there is no option for the patient to obtain the next dose from a community pharmacy. Your place should have a policy that relates to all of this that complies with applicable laws and has at least been run past your state Board of Pharmacy and other interested entities that could wreak havoc. They need to clarify what is to be done in these scenarios. It's not one of those things that are (any longer) "Okay because that's the way the doctor ordered it." If you don't trust your facility's policy, you could ask for an opinion from your BoN/BoP.

    I wouldn't be as worried about what the patient does with it (that's on them, as long as they are given appropriate instructions and the dose is properly labeled with clear instructions), but rather about dispensing laws. As already mentioned, this is "dispensing."

    Remember that if a situation arises where you do need to send a dose with the patient according to established policy, you aren't documenting that you administered it but rather that it was dispensed/sent with patient. Add in all the CYA stuff like, "as instructed by __________, Supervisor" and/or "according to policy # ___________", etc.
  10. by   Wuzzie
    Quote from canoehead
    We do it all the time in the ER with full knowledge of the pharmacy. They get enough to make it through til their script can be filled.
    We did that in my ED but it was a commercially pre-packaged dose card (we called them a 6 pack) of Vicodin that was labeled with instructions and the patient name. We stopped the practice when the police brought in a patient who was in possession of multiple 6 packs that patients had sold to him but had stupidly left the patient labels on them. Apparently the cards had a street value of $300 and this guy was dealing them. Of course the names were extremely familiar to us so those people were bummed when all they got in the future was Tylenol.
  11. by   dudette10
    Quote from ceegee69
    Hello,

    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?

    Thoughts?
    It is a prescription, just like one written and dispensed at a pharmacy. No issue there. Just document that you gave it.
  12. by   dudette10
    In reading the other replies, I guess I'm wrong. Oh well, not the first time.
  13. by   SpankedInPittsburgh
    Pretty much no way never. I'm not going to sign off that I administered a med on a patient who already was discharged and that (in fact) I didn't administer the med to. I'm not a pharmacist so I'm not dispensing meds as that is outside the scope of my practice as a nurse. If the doc wants to hand off a goodie bag that's up to him but I ain't doing it.
  14. by   Cara_SN
    Unless there was a pt Hx logged or there was a need for suspicion, I would do the same! Too many people are judgemental. We are here to help and not judge.

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