Narcotic management in the home

[gsstover]

I work for a hospice connected with the local hospital. The nurses obtain medications from the hospital pharmacy and deliver them to the patients. We have begun counting the narcotics at each nurse visit and have a medication record sheet that the family fills out with each dose given. This sheet becomes part of the patients chart. Do other hospices have this policy andhow do others monitor narcotic use in the home?

Thanks!

[jeannepaul, BSN]

We never carry meds to patients homes, the pharmacy delivers them. No, we do not count each med at the visits. the only time a count is done is if the pt is on crisis care or at the death.

[AtlantaRN, RN]

we obtain medications from a contracted compounding pharmacy, we deliver to the patients home, and get them to sign a "release" that states the name of medication and quantity delivered, and we turn this into our clinical manager.

linda

[shrinky]

We are also a hospital based Hospice but we get our meds from our Cancer Center where we have our outpatient pharmacy for Hospice. We also count all meds each visit as we have to reorder their meds for our next visit. We ask the family to keep a record of meds given so we basically know how much pain our patient has so we can adjust accordingly. If we suspect diversion we take out only a few days supply at a time instead of 2 weeks supply. We also have them sign when meds are delivered and that is a part of the record.

[tewdles, RN]

Please review state laws regarding transport of medications, particularly controlled substances from pharmacy to client, you have to protect your license. I am familiar with hospice nurses counting meds at visits to insure that there are adequate supplies to meet pt needs until next delivery. This explanation is satisfying for families and patients and allows us to keep track of meds so that diversion or other issues are identified quickly. As case nurse, I generally provide a simple log for the families to use to keep track of prn or break through dosing. This is helpful to everyone to determine what adjustments may be needed in the POC.

[dosamigos76, RN]

When I worked in states where I could deliver medications, I always had the family sign stating what they had received. It protects me and verifies what is or should be in the home.