Jump to content

Hospice Nurse Transporting Patient Medications

Hospice   (17,713 Views 14 Comments)
by Mazzi Mazzi (Member)

3,381 Profile Views; 88 Posts

We have a disscusion at work regarding the Hospice nurse picking up the patients medications (some narcotics). Some feel this goes against Federal Regulation, some State regulations, some that its OK. Does any one know were we can find the information on Transporting Medications? Thanks in advance.

Share this post


Link to post
Share on other sites

dosamigos76 has 7 years experience as a RN and specializes in Hospice.

348 Posts; 5,080 Profile Views

It all depends on the state you live in and their regulations. For example, in Alabama where I moved from, you DID NOT transport ANY medication. Here in Texas, you can transport ANYTHING. Personally, I don't like to carry narcotics with me unless it is an emergency.

HTH

Cheryl

Share this post


Link to post
Share on other sites

southcarolina716 has 17 years experience and specializes in too many to list..

6 Posts; 952 Profile Views

I'd be interested in knowing the answer to this as well. As a CNA we are routinely delivering meds, we are expected to do this to help our RN's it bothers me to have that responsibility, I never would have thought of it bothering the nurses to be honest. On top of carrying the meds, when I deliver them the patients often have questions about them and I am often playing phone tag trying to get a nurse on the phone for them.

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

1,714 Posts; 12,218 Profile Views

I have worked with hospice nurses in Iowa and Illinois, and in both states, the nurses routinely picked meds up from the pharmacy and delivered them to the patients' homes.

Share this post


Link to post
Share on other sites

CANRN has 17 years experience as a MSN, RN and specializes in Hospice and Palliative Care, Family NP.

238 Posts; 4,708 Profile Views

I live in Ohio and have delivered meds to patients. When doing an admission, we usually stop by the pharmacy and pick up the comfort meds, this includes narcoticcs, especially if the patient maybe having some discomfort.

We also have a courier that delivers meds daily as well. If we get to a patient's home and need emergency delivery, we can call and they are great about going to pharmacy and picking up meds and getting them to us quickly!

Share this post


Link to post
Share on other sites

dosamigos76 has 7 years experience as a RN and specializes in Hospice.

348 Posts; 5,080 Profile Views

I never would have thought of it bothering the nurses to be honest.

It can be a bit scary going into some neighborhoods at night... add that people are watching you and they identify you as a nurse and they know you can carry narcs...

Or you have a family that claims "She didn't bring all of this" even though they signed a receipt of delivery.

That's the potential danger.

Cheryl

Share this post


Link to post
Share on other sites

CANRN has 17 years experience as a MSN, RN and specializes in Hospice and Palliative Care, Family NP.

238 Posts; 4,708 Profile Views

It can be a bit scary going into some neighborhoods at night... add that people are watching you and they identify you as a nurse and they know you can carry narcs...

Or you have a family that claims "She didn't bring all of this" even though they signed a receipt of delivery.

That's the potential danger.

Cheryl

I understand about some of the neighborhoods and at night. However, I personally, have never taken meds at night as the pharmacy is not available to outpatient services.

If there is a concern about meds in a home, especially narcotics, we have lock boxes that we provide, and if that is not effective, we recommend inpatient placement into LTC facility. There is always a backup plan.

Share this post


Link to post
Share on other sites

dosamigos76 has 7 years experience as a RN and specializes in Hospice.

348 Posts; 5,080 Profile Views

I personally, have never taken meds at night as the pharmacy is not available to outpatient services.

If there is a concern about meds in a home, especially narcotics, we have lock boxes that we provide, and if that is not effective, we recommend inpatient placement into LTC facility. There is always a backup plan.

I agree about options you have if you are concerned regarding diversion.

We have a local pharmacy that will send out a pharmacist for us and fill any script. It is wonderful when you have a change in a patient that no one anticipated or whatever...

Cheryl

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

78 Posts; 2,839 Profile Views

We have a contract with walgreens and here in Oklahoma I am have to deliver meds some (I work night shift). Yes some neighborhoods can be scary but I have had only one problem while delivering meds. guy asked what was in my bag and I told him my college books (I carry a book bag) and he went on.

Share this post


Link to post
Share on other sites
Are you a credible source? Add your Credentials, Experience, etc.

474 Posts; 3,480 Profile Views

We don't make it a frequent thing, but we will deliver medications if there is no way a family member can pick up. We contract with a pharmacy that delivers but not in the middle of the night.

Share this post


Link to post
Share on other sites

curiousauntie has 26 years experience and specializes in LTC, Sub-Acute, Hopsice.

167 Posts; 4,403 Profile Views

At my hospice, if a patient needs meds NOW (can't wait for the delivery from Hospice Pharmacia the next day or it is a weekend that they cannot get a delivery) we will get the script and have it filled...if the family cannot get to the pharmacy we will take it, wait for it and take it to the home. I frequently get scripts for new admits that need morphine NOW and have it filled and take with me to do the admission. What we cannot do is carry any med that is not for that patient. This caused one of our nurses to be terminated last year.

She had been at a death pronouncement and had an unopened Fed Ex bag with an unopened bottle of morphine in it that the family wanted her to send back. It had actually been delivered while she was pronouncing the patient, but the driver left before anyone was able to tell the driver that they wanted to refuse the package. They had been arguing with her about opening it and destroying it, so instead of causing more pain to the family then the death already had, she just put it in her car. She then went to a nursing home to admit a patient, who was actively dying and in respiratory distress. She asked the nurse at the LTC how long it would take to have morphine delivered from their back up pharmacy, and was told it would be at least 4 hours. The patient resp rate was over 40, very wet and he was also clearly in pain. She went to her car and got the morphine and gave him the ordered dose. He began to calm down, his resp rate decreased to a more manageable level and after a dose of Levsin, his secretions started to dry up. All of this was in front of the family, one of who was a nurse practitioner. They were very happy with the lessening of the symptoms.

At that time the patients doctor came in and she went to get him to write a script that she would take to a pharmacy to get filled for the patient. During the 5 minutes she was out of the room, the facility DON came in the room and saw the morphine on the bed side table. Our nurse had inadvertently placed it there instead of in her bag or pocket. The DON made a big stink, in front of the family, calling our office to demand that something be done about our nurse.

Now, I understand (as did the nurse) that we are not to carry meds in our cars, that we are not to give meds prescribed for one patient to another, and that we should never place meds on a bedside table in any type of facility (as this is a safety issue for all of the demented wanders). BUT...

I also know that there are times when the bending or breaking of a rule is in the best interest of the patient. If this patient had been in a private home, not a nursing home, the fact that she went to her car and got the medication that made the patient comfortable would NEVER have come up. The family went out of their way to try to save the nurses job, they had witnessed the facility DON yelling at my director to "do something" about "that nurse" and felt horrible that the nurse was probably going to be fired.

Until that time, I, along with every other nurse in my office, usually had a little cache of "emergency" meds hidden in our cars. (mine was under the spare tire) That day, we all got rid of them. Our director called us in and said that she was leaving the office an hour early, and maybe we should all check our cars, and if we happened to find anything there that should not be there, use each other as witnesses and destroy it as there was to be an inspection of our cars the next day. That is just what we did, laughing and crying as we said good-by to our good friend and co-worker.

By the way, the patient died about an hour after the Morphine and Levsin, comfortable and with his very grateful family at his side.

Share this post


Link to post
Share on other sites

CANRN has 17 years experience as a MSN, RN and specializes in Hospice and Palliative Care, Family NP.

238 Posts; 4,708 Profile Views

At my hospice, if a patient needs meds NOW (can't wait for the delivery from Hospice Pharmacia the next day or it is a weekend that they cannot get a delivery) we will get the script and have it filled...if the family cannot get to the pharmacy we will take it, wait for it and take it to the home. I frequently get scripts for new admits that need morphine NOW and have it filled and take with me to do the admission. What we cannot do is carry any med that is not for that patient. This caused one of our nurses to be terminated last year.

She had been at a death pronouncement and had an unopened Fed Ex bag with an unopened bottle of morphine in it that the family wanted her to send back. It had actually been delivered while she was pronouncing the patient, but the driver left before anyone was able to tell the driver that they wanted to refuse the package. They had been arguing with her about opening it and destroying it, so instead of causing more pain to the family then the death already had, she just put it in her car. She then went to a nursing home to admit a patient, who was actively dying and in respiratory distress. She asked the nurse at the LTC how long it would take to have morphine delivered from their back up pharmacy, and was told it would be at least 4 hours. The patient resp rate was over 40, very wet and he was also clearly in pain. She went to her car and got the morphine and gave him the ordered dose. He began to calm down, his resp rate decreased to a more manageable level and after a dose of Levsin, his secretions started to dry up. All of this was in front of the family, one of who was a nurse practitioner. They were very happy with the lessening of the symptoms.

At that time the patients doctor came in and she went to get him to write a script that she would take to a pharmacy to get filled for the patient. During the 5 minutes she was out of the room, the facility DON came in the room and saw the morphine on the bed side table. Our nurse had inadvertently placed it there instead of in her bag or pocket. The DON made a big stink, in front of the family, calling our office to demand that something be done about our nurse.

Now, I understand (as did the nurse) that we are not to carry meds in our cars, that we are not to give meds prescribed for one patient to another, and that we should never place meds on a bedside table in any type of facility (as this is a safety issue for all of the demented wanders). BUT...

I also know that there are times when the bending or breaking of a rule is in the best interest of the patient. If this patient had been in a private home, not a nursing home, the fact that she went to her car and got the medication that made the patient comfortable would NEVER have come up. The family went out of their way to try to save the nurses job, they had witnessed the facility DON yelling at my director to "do something" about "that nurse" and felt horrible that the nurse was probably going to be fired.

Until that time, I, along with every other nurse in my office, usually had a little cache of "emergency" meds hidden in our cars. (mine was under the spare tire) That day, we all got rid of them. Our director called us in and said that she was leaving the office an hour early, and maybe we should all check our cars, and if we happened to find anything there that should not be there, use each other as witnesses and destroy it as there was to be an inspection of our cars the next day. That is just what we did, laughing and crying as we said good-by to our good friend and co-worker.

By the way, the patient died about an hour after the Morphine and Levsin, comfortable and with his very grateful family at his side.

Ya know, some nurses just don't get it! Instead of seeing how that fast intervention benefited the patient, she climbed on her high horse and destroyed someone's life. HER behavior (the DON's) was more inappropriate than the nurse that had the best interest of her patient and family in mind. Afterall, the family witnessed her behavior!

Was it right what the hospice nurse did? That is another debate! Personally, I side with the hospice nurse. I sure hope she found another hospice position and is able to provide comfort and compassion to other families and patients!:bowingpur

Cindy

Share this post


Link to post
Share on other sites
Guest
This topic is now closed to further replies.
×