question about narcotic dispensing

Zookeeper3 · Feb 9, 2010

Without knowing what type of setting you practice it's very hard to respond... a rehab? nursing home? home for the mentally disabled, like a group home?

Regulations vary based upon that.... can you elaborate a bit?

kappykatlpn · Feb 9, 2010

Hi,

I work in a nursing home.

ty

kathy313 · Feb 9, 2010

We had several residents who were in/out of the hospital. We sometimes did keep the narcs, once the resident came back from the hospital, we used them....provided we did have the order....pharmacy did send the new order. If the resident had been out for a significant time, they were sent back.

You're right though, there is a large amount of waste when it comes to nursing home meds, you'd think they can come up with a more cost-efficient answer. I think, in part, that's what the computerized med pass was supposed to do, but many nursing homes don't use it.

Emergency RN · Feb 9, 2010

Aside from the waste, the bigger issue is the legality of it.

For me, the huge red flag here is obviously the question of why is your unit holding on to narcotics of patients that are no longer there? Granted, people do get re-admitted, but having narcotics (or any meds for that matter) laying around that technically belong to "nobody" is a huge risk management issue, IMHO.

The medications, if paid for under a patient's charges, should have been given to the patient on discharge as they were already dispensed by pharmacy to him. In other words, your facility is only acting as the care taker in the administration of his meds. Once he goes home, his property (clothing, medication, whatever) should all go with him. The only way around that is if the not yet administered meds were returned to pharmacy for a patient credit, which in this case, it obviously wasn't.

I would suggest that you tug on some higher up's coat in your institution, as this situation makes it rife not only for waste but also is an inviting target for theft of narcotics.

kathy313 · Feb 9, 2010

Aside from the waste, the bigger issue is the legality of it.
For me, the huge red flag here is obviously the question of why is your unit holding on to narcotics of patients that are no longer there? Granted, people do get re-admitted, but having narcotics (or any meds for that matter) laying around that technically belong to "nobody" is a huge risk management issue, IMHO.
The medications, if paid for under a patient's charges, should have been given to the patient on discharge as they were already dispensed by pharmacy to him. In other words, your facility is only acting as the care taker in the administration of his meds. Once he goes home, his property (clothing, medication, whatever) should all go with him. The only way around that is if the not yet administered meds were returned to pharmacy for a patient credit, which in this case, it obviously wasn't.
I would suggest that you tug on some higher up's coat in your institution, as this situation makes it rife not only for waste but also is an inviting target for theft of narcotics.

Definitely agree, if someone was d/c'd home or passed, those meds went back to pharmacy. The criteria they used though...if the facility was hanging onto the room for the resident (hospital admission) then we usually kept the meds too. At times, it was ridiculous....counting all the narcs.

vanlo001 · Feb 9, 2010

Your nursing license is on the line here. Think of it that way. When a patients discharged the meds need to go. Either with the patient or back to pharmacy. If it's still hanging out when the patient is readmitted I would send those narcs back to the pharmacy and have new ones reissued or save that script and give them to the patient on discharge with this next discharge. This is a serious infraction (having narcotics laying around for discharged patients). There should be a policy fir the handling of narcotics fir residents and what to do on discharge. If there is not encourage your facility to create one.

kappykatlpn · Feb 9, 2010

ty for all the reply's. Seems like there is no good situation here. The patient was sent to the ER, via ambulance, so no meds go with him. We were expecting him back, thats why we kept them. We are not allowed to send Narc back to pharmacy. Not sure if its a pharmacy law, or a michigan law. But if a resident dies, or leaves. If they don't go with him we must destroy the narcs. So this patient has 90 vicodin, we should have destroyed, and he comes back we must get new drugs, and delay pain management, because when he came back to us hospital did not send actual scripts for the narcs, just the transfer sheet with the med orders. And getting ahold of the in house doctor is not always fast. Are there people out there that just sit around and try to think of ways to make the nurses jobs harder?? Sure seems like it!

mamamerlee, LPN · Feb 9, 2010

You held on to his meds for TWO WEEKS ???? Two days, maybe, but not much longer. Your facility MUST have a policy for when to dispose of unused meds. Find the policy manual, ask the DON or administrator and get something established.

No, you can't give these meds. No, NO, NO, NO!

sarasidnic · Feb 9, 2010

Looking at this from a different perspective; I am a nurse in recovery and I was hired to work in a nursing home.

I was working on 3-11, most supervisors are gone before 5pm. I of course am responsible for all the narcs, which is fine. However, there was an open bottle of roxinal in the count on a patient who died 2 months prior to me setting foot in the building. I refused to accept responsiblity for this and drew alot of attention to myself. I was not worried that I would be tempted to take it, I was worried about all the different people that have access to the drug besides me. If someone tampered with it I would automatically be a suspect which is par for the course but more importantly it is a "HUGE" violation of the facility, state and federal drug regulations. I would have faced a diciplinary action if the board decided to audit the narc book even if their is nothing missing. I would be reprimanded for policy and drug violations. The currrent policy states that all narcotics are to be removed from count if a person dies,is d/c or out of the facility for more than a week. The director of nursing is supposed to destroy the meds with a supervisor to witness. If a patient went to the hospital but was coming back in a week, a director might not throw the drugs away but they should be removed from count

My advice, CYA. I quit at the end of the second week.

cat16

jnrsmommy · Feb 9, 2010

What pharmacy do you guys use? Most of the ones I'm familiar with, you can send the narcotic back, but you have to notify them that you have a narcotic pick-up and there is a form that needs to be filled out and sent back as well.

Also, you should have a regular emergency medication kit, as well as an emergency narcotic kit, so that pain control can be maintained while waiting for the pts meds to be delivered.

morte, LPN, LVN · Feb 9, 2010

You held on to his meds for TWO WEEKS ???? Two days, maybe, but not much longer. Your facility MUST have a policy for when to dispose of unused meds. Find the policy manual, ask the DON or administrator and get something established.
No, you can't give these meds. No, NO, NO, NO!

why not? same patient, same med......