I have a question. Seems to be a confusion where I work.
We had a resident who was on some narcs (vicodin) We got the narcs in. He was dc'd to the hospital a couple of days later. Two week later (yesterday) He returns to us. Still has order for vicodin. Now, we want to use the vicodin we already have of his from before. Some of the nurses are saying we can't , we need to get more from the pharmacy. Now the way I understood the DEA regulations was that the pharmacy could not dispense narcs to us without a valid script. These meds have already been dispensed to us. So why could we not use them???? Seems like such a waste if we couldn't.
Very good question!!! I'd like to hear other LTC nurses respond. In our state and our pharm ( Omnicare) we cannot sent narcs back with the drivers.
We have held on to meds for residents that are in and out of the hospital within a couple days, but with the newer regs...What is the right answer to this? It is such a waste to waste them and I can see the cost factor, but what is the legal answer?
I'd think that as soon as they are d/c'd or admitted to the hospital, the meds should be pulled and destroyed since the orders/ script expires when they get the new orders upon admission??
As far as the emergecy boxes....what a joke. Now we need an actual new order saying that we can use this while we wait for the actual supply to come in. It has to be a written order or verbal order that the md gives to the pharmacy. Then the pharmacy gives us permission to use the box via a faxed form. How long do you think this takes in the LTC setting??? FOREVER!!
well, obviously my question was answered. Should not use the med that we should not still have in the first place. Doesn't change the reality of the situation. We do have a back up supply of narcs, but we cannot use them until the pharmacy give us permission, and they will not give permission unless they have a written script from the doctor or a verbal order from the doctor, and that is alway not easy. In the mean time the patient is waiting for pain meds. ty for all the replys, and I do understand the issue we obviously of having narcs in patients in the drawer way to long. Something management is going to have to address. We want to give the narcs to the DON but she doesn't have time to destroy so we hang on to them. Another issue of many. And We are not allowed to sent narcs back to our pharmacy at all.
But I would still love to hear opinions of other LTC nurses and how its done it other places.
At my old facility, if the resident was sent to the hospital we could hold onto the narcs/meds for a few days. If they died, got discharged, etc, they were sent back to pharmacy. Pharmacy could then dispense them again to another unit. Unfortunately narcs have to be hand delivered back to pharmacy during the day shift. And whether or not that got done in a timely matter is a whole other story. We are also allowed to go to other units and sign out narcs if we need one and pharmacy is not open.
Specializes in Gerontology, Med surg, Home Health.
Our pharmacy will NEVER take back narcotics..ever. There are only a few meds we can return for credit. To the poster who suggested giving the meds to the patient because they paid for them....WE pay for them under Medicare consolidated billing and don't send narcs home with residents without a specific doctor's order. Our policy says we will remove discontinued narcotics in 'a timely manner'. If we specify a time we'd get hung by the DPH. There is altogether too much waste in this area. I've written to my governor 5 times and to the President twice...didn't get a response either time.
Our residents come back to us. We keep their meds, including narcs, for reconciliation with the discharge orders when they come back. WHy on earth wouldn't we use them?
since I'm a UK RN working in a hospital I'm curiuos don't USA
hospitalls discharge pt with meds for a week?
If they are discharged from LTC they are given prescriptions to fill at the pharmacy..same with acute care. That is in the upstate New York area. Not sure if it is the same everywhere.
At our facility, if a Resident is out for 24/hrs or longer they are considered a readmit upon returning. At the 24/hr mark, all meds are pulled from the cart. Meds are picked up by Pharmacy on Mondays. Narcs are locked away and are picked up 1/mo. If Res. comes back on Sunday with orders for the same meds then we put them back on the cart and use them. Same with Narcs. So its basically the luck of the draw, as to what meds get reissued, or sent back.. Its a pretty simple policy that works well at our facility. No narc is hanging around for more than 30 days.
morte - - these meds should have been disposed of, unless there is a policy that says to hold onto them indefinitely.
no, not necessarily. many times we send a pt to the hospital knowing they will be back. most times they are not "technically" discharged in the system, just out on transfer to the hospital. so if we know they will be back and we are reasonably sure they will return with the same narcotic order then i think we should keep the med on the cart. otherwise it's just throwing money down the toilet literally because thats where all unused narcotics go. in LTC you can't return narcs to the pharmacy.
we've had this come up in our building before. our pharmacy consultant said it is fine to keep the med if we have a reasonable expectation that they will return. when they do return, we will need a new order and a new prescription but there is nothing wrong with keeping and using the same pills.
the reason we can keep them is that you don't go by the order on the narc box/card itself. you always, always go by the order in the chart. so if your order covers you, you are good to go.
mamamerlee, LPN
949 Posts
morte - - these meds should have been disposed of, unless there is a policy that says to hold onto them indefinitely.