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.
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.
Exactly the same for my facility. We can not send narcs back to the pharmacy for any reason - we flush them down the hopper (which could lead to a whole other thread). There is no reason in the world why you couldn't reuse these meds. It is very reasonable to discharge a resident to the hospital and expect that most of the medications will be reordered when they return.
While they are out, the narcs are counted at every shift change right along with everyone else's.
We do the same thing as far as wasting narcs after DC as it is a Regulation Pharmacy can't take back Narc's. Question though who is the responsible person if Narcotics sent home with patient from nursing home are used in suicide? I know technically they have "purchased them" but recently I wass made aware of a facility sending 200+ morphine home with a discharged patient that was later used for a suicide. Where does the responsibility lie in this case?
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
According to my state pharmacy regulations:
18VAC110-20-520. Drugs in long-term care facilities.
Prescription drugs, as defined in the Drug Control Act, shall not be floor stocked by a long-term care facility, except those in the stat drug box or emergency drug box or as provided for in 18VAC110-20-560 within this chapter.
d. Long term care facilities shall destroy discontinued or unused drugs or return them to the pharmacy within 30 days of the date the drug was discontinued.
Please check the specific regulations in your state and your facility policy and procedure.
In the nursing home where I work a ressidents meds are removed from the med cart and wasted if they are away from the facility for over 7 days so we would not have even had the narcs available.
You need policy. The policy where I work is easy to follow. Once the resident has been in the hospital long enough that they will be a new admit when/if they return all of their meds are sent back to the pharmacy. If a resident passes, the meds are sent back to the pharmacy. We do not return liquid meds if opened, they are wasted. It requires two nurses to sign if liquid narcs are wasted. Policy is your best friend.
If a resident goes to the hospital and is in an obs status, we will keep the medications. If admitted, the narcs are destroyed and the remaining medications are returned for credit. If our patient had a script for 90 vicodin, our pharmacy would never send 3 cards of thirty pills. They will send 1 card of 30 and wait for us to send a request for a refill.
The key factor is whether the resident was actually discharged from the long term care facility which would result in a new admit upon return from the hospital. The OP says the resident was discharged. Ironically, in my area, two weeks triggers an automatic discharge per bed hold policy of most facilities. In other words, the narcs would have been destroyed.
Nascar nurse, ASN, RN
2,218 Posts
Exactly the same for my facility. We can not send narcs back to the pharmacy for any reason - we flush them down the hopper (which could lead to a whole other thread). There is no reason in the world why you couldn't reuse these meds. It is very reasonable to discharge a resident to the hospital and expect that most of the medications will be reordered when they return.
While they are out, the narcs are counted at every shift change right along with everyone else's.