Residents leaving facility with scheduled medications

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I was wondering how other facilities handle it when residents leave with family during a time they will have scheduled medications, especially narcotics. Do you hand the whole sheet over to a family member to have them administer and then return? Do you put them in a separate container? Does someone sign for them and then sign they were returned? Any information would be appreciated.

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Specializes in LTC, Memory loss, PDN.

we don't send any paperwork, the families are not allowed to document on staff paperwork

two staff members count (nurses and or CMAs), the family is offered to have the med counted in their presence

but either way, the family has to sign

we cannot put in a separate container as this would be dispensing (in this state)

if the med is carded, we do send the whole card

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Specializes in LTC,Hospice/palliative care,acute care.

We require 72 hour notice to obtain LOA meds from the pharmacy.They come in separate little bags-we can also print out the instructions.The family signs the resident out and are responsible for administering them.The last time I sent anyone LOA with narcs we had to obtain a separate script from the doc for the pharmacy to release a few doses,I'm not sure if we still have to do it that way. We sign "LOA" status on the MAR.If the family does not admin the meds properly we will communicate this to the doc,he can then decide if future LOA's will be "against medical advice"

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Specializes in Psych, Skilled Nursing.

We send the whole card but do a two person count before giving the card to the RP. Then we go over the count with the family and have them sign.

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Specializes in LTC.

Most of the facilities I have worked for have a "Medication Reconciliation" form. (Always forms, lol). Anyway, 2 people count and sign off on the form the count of what was sent. We only send "carded" meds, no OTC's. The Responsible Party signs the Med Rec form as well and it is kept in the front of the chart. When the res returns, another count is done by 2 nurses/med aide and the reconciled sheet stays in the chart. On the narc count sheets, 2 nurses sign off that "24 sent with res OOP 9/3/13", then "res returned with 20 on 9/5/13" as an example.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Thanks to all of you for the responses, that's very helpful!

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Specializes in retired LTC.

How long will the pt be out of the facility? If we can give something a little early, or a little late, that should take care of any med issues, except for pain meds. We were not to send any of our meds out - that was considered DISPENSING (not in our practice act).

If we were to need meds for home, they had to come from pharmacy. Hence we had policies requiring advanced notice (it varied per pharm/facility). Pharmacy would send a baggie with meds in little bottles with directions for the family which we repeated. If families failed to give us advanced notice (so we could requisition meds in a timely fashion), SORRY, no meds!

There's a phrase out there - lack of pre-planning on your part, does not make an emergency on my part!

I shudder to think of the problems if we were to send our med cards out (tampered with, coffee spills, stolen, lost, dog ate it, kids ate it, forgot to return them, etc etc).

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Wow, that seems a bit harsh. We send our med cards out with the family. I would not consider saying, "sorry, no meds" to them, they are 'their' meds after all, and it is well within their right to go out of the facility with their family. At what point are policies actually a punishment for being elderly, frail, and dependent?

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Specializes in LTC,Hospice/palliative care,acute care.
Wow, that seems a bit harsh. We send our med cards out with the family. I would not consider saying, "sorry, no meds" to them, they are 'their' meds after all, and it is well within their right to go out of the facility with their family. At what point are policies actually a punishment for being elderly, frail, and dependent?
It's my understanding that this is a regulation in my state. The pharmacists have lobbied vigorously to prevent us from "dispensing meds".
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I guess I am curious now, how is it considered dispensing? They have already been dispensed by pharmacy, they should have pharmacy labels with the residents name, and they are being sent with the resident they belong to. Also curious, does the insurance then have to pay for duplicate pills? If we have to waste meds and thus run short, the insurance will not cover the cost so the facility must cover. How is this covered for the resident?

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Specializes in LTC,Hospice/palliative care,acute care.

I know-it hurts my head ,too. Pharamacists are a powerful profession and that's the way they want it. There is no extra charge, I believe they take the doses out of the next refill to even it out. Since we don't send our supply they must generate new labels with instructions for the res/family to follow and since they consider a nurse pulling the pills out the supply at hand "dispensing" they then package just the doses needed for the LOA. This is the practice for every facility in this area that I have worked in-every LTC around here just does not send the supply of meds on hand for a short LOA.

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How long will the pt be out of the facility? If we can give something a little early, or a little late, that should take care of any med issues, except for pain meds. We were not to send any of our meds out - that was considered DISPENSING (not in our practice act).

If we were to need meds for home, they had to come from pharmacy. Hence we had policies requiring advanced notice (it varied per pharm/facility). Pharmacy would send a baggie with meds in little bottles with directions for the family which we repeated. If families failed to give us advanced notice (so we could requisition meds in a timely fashion), SORRY, no meds!

There's a phrase out there - lack of pre-planning on your part, does not make an emergency on my part!

I shudder to think of the problems if we were to send our med cards out (tampered with, coffee spills, stolen, lost, dog ate it, kids ate it, forgot to return them, etc etc).

When our residents go to stay with family (or whatever) for a few days, our policy is that the 3rd shift LPN is to set up all their meds the night before in little baggies to take with them. This includes narcotics. We have the resident and/or family co-sign the narcotic sign out sheet before they go. I have sent entire cards of Norco with residents before.

I hate doing this, and have complained that it's dispensing. I've more or less been told to shut up and do it, the implication being that I'm lazy and just trying to get out of the extra work.

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