Repackaging Medications

[Pinupnurse76]

I need a bit of help. I am the Director of Health Services that has 7 group homes for IDD/DD individuals. To dispense medications we use a bubble pack system. Medication aides are certified to dispense medications. It was reported to me this am that the medications that were to be dispensed to one individual today were "missing" a few hours later, these three pills were found in the medication box, placed back in the bubble pack, and the back of the bubble pack was taped. Does anyone see a problem with this? I checked with our pharmacy and the pharmacist stated that this was repackaging. Virginia regulations states a medication aide cannot repackage or label a medication, however, this is what happened. I recommended an investigation and suspension. My boss just wants a corrective action. Does this send a bad precedent? I am so confused and quite annoyed.

[psu_213, BSN, RN]

Yes, I definitely see a problem with this.

I believe an investigation is in order. Depending on the findings of the investigation, a suspension might be in order, but corrective action/education might be the way to go.

[klone, MSN, RN]

I think you need to figure out WHY it was replaced and taped. Did the patient refuse them? Either way, we instruct staff that if a medication is opened, it cannot be reused, and it must be wasted.

Maybe I'm super lenient, but I would simply counsel the employee on appropriate handling of medications, help them understand the risks of the practice and what proper procedure is. Unless you have ongoing issues with this person with crappy care and not following procedures or being unsafe, I wouldn't do a suspension OR a corrective action.

Counseling/coaching, write it up and keep it in your anecdotal file. If there is a pattern of occurrences, then begin the corrective action process and escalate as needed.

ETA: I'm assuming we're NOT talking about narcotic medications or other scheduled meds, correct?

[PeakRN]

It sounds like there is quite a bit of risk involved here and should be investigated. Are you sure that the medication aide was the one who repackaged the meds? Do they know that this is outside of their certification? Has there been a history of this happening before?

I'm not sure if a suspension is in order, especially if the person didn't know that they are not allowed to repackage meds and did it in good faith to be used later, but there is definitely need for education and some form of written policy regarding the handling of medications. I would certainly keep a record of this like klone suggested to make sure that it doesn't become a pattern.

[MunoRN, RN]

Whether this would fit the definition of "repackaging" depends on how the medications are initially prepared. It's not legal for medication aides to "dispense" medications in Virginia, so if that's really what your facility is doing then you've got bigger problems, not even Physicians can legally dispense without obtaining a separate license.

It sounds as though your MAs are administering rather than dispensing, in which case placing medications back in the stock supply is not considered "repackaging".

[FolksBtrippin, BSN, RN]

You are putting the cart before the horse.

Find out what happened and why. Then decide whether this is something that requires disciplinary action.

If the med aide was trying to do the right thing then education is the correct response.

I think it's unlikely you have a situation other than that.

[Here.I.Stand, BSN, RN]

Suspension? Do you advocate disciplinary action for med errors too? Do you honestly believe the med aide had reasons other than thinking it wasteful to throw (possibly very expensive) pills in the trash? If not, education is the appropriate response; note a verbal coaching in their file.

[Silverdragon102, BSN]

Investigation yes, find out reason to what happened and form a correction action plan. Suspension may be a bit far as reason may just require some re-education.

[inthecosmos, BSN, MSN, RN, APRN]

As everyone as mentioned, it sounds more appropriate to figure out why and educate. Most people aren't doing things incorrectly on purpose. I don't believe suspension is warranted if it has never been addressed before.

Studies have proven that staff respond better to education and process improvement, not reprimand, suspensions, and firings. Especially for first-time offenses.

[NutmeggeRN, BSN]

I think counseling is appropriate. Personally, one would think that if the pill was easily identifiable and popped out inadvertently, it IS a waste of $$ to toss away. I get all the reasons why, I really do. But I also think the pharmacy regulations are crazy. The stuff that "expires" in the LTC facility is good at home until the exp date on the label, not 30 day after opening...$$$$ for the pharmacy provider.