Residents leaving facility with scheduled medications

Specialties Geriatric

Published

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.

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.

You could always complain to the board and see what they say. Certainly your facility would assume it's you, though

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

"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."

This is one thing I was wondering about- if a narc is in a container other than the prescription box/card, a resident could potentially be arrested for carrying narcotics illegally. (Not that many residents leave the facility and have police interactions, but you never know)

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Specializes in retired LTC.

To MarggoRita - Mine is not an atypical policy in many LTCs. This policy is established by our pharmacy suppliers. I can sympathize when families make plans on short notice, but these are the rules. I've seen these polices in admission info for families, and we put signs out reminding families around the holidays. So the families have been informed.

We have no control and it's not considered a punishment for the pt, but rather a safety safeguard. That's why we also have policies re meds that come from home - families/pts want us to use up home meds but how do I know what that little yellow pill is or that the red/white capsule has not been opened (that's how Tylenol was tampered with some years ago in that national scandal). And just FYI - I've never seen unused PRN pain meds returned to us - were they all used by the pt?

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The best way I can explain differences is that I (and you) administer meds; pharmacists dispense. We can't be secondary dispensing middlemen. The sequence is to dispense, then administer. Not dispense, dispense, administer.

Many years ago at my first hospital job on 11-7, we would hurry up and give a quick check to see if we needed any meds for our shift that the pharmacy had not yet filled. We'd go down to the 'the night pharmacy' where the 11-7 RN supervisor (with pharm keys) would give us anything needed. That practice was stopped way back then because it was determined that she was 'dispensing'.

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There should be a Pharmacy P & P manual around somewhere in your facilities. That manual is part of the contractual agreement with your pharmacy provider. It would be outlined there how to obtain meds for home visits. That should be your guide and you should be following it. Otherwise, you should have an in-house P & P on how to prep for home meds. But as many have said, that in-house policy cannot superceed Board of Nursing/Pharmacy and Dept of Health rules & regs.

Each State may be different so you should really know the specifics and not be breaking any rules. Lord help you if you make a mistake - that's when you'd really have to worry about lawsusits and licensure loss as well as your job. And just know, your facility will not back you up if you're wrong!

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At my facility we send the entire cards with a medication reconciliation form. We are absolutely not allowed to remove the meds from the the cards and in anyway prepare them. They have to stay in the cards where they are labeled by the pharmacy. At first I was a little worried that the families might not return the meds with the resident and that it would be a big hassle to get them replaced but so far that hasn't been an issue. All of the families that I have dealt with so far treat the meds like gold, follow the directions and return the cards with no issues including narcs.

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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 NICU, Peds, Med-Surg.

I've read everyones' replies, but I didn't see INSULIN addressed........and what about family checking their blood

glucose levels? What if the family/ resident can't/won't check the level, or give the insulin? I'm assuming there

would be MAJOR documentation (obviously), and the family accepts responsibility if there are problems?

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We require 24 hours notice so that we can contact the pharmacy and obtain LOA meds for the time that the person will be out.

Most of my residents never go for extended LOA out of the facility. So the families tend to come in at a time where the meds can be given before they leave and they are back before the next set of meds are due. The major holidays we do see residents out from morning to bed time. The families know they need to let us know at least 24 hrs in advance so that we can order the meds from the pharmacy.

Not really sure the hows/whys of the charges (who pays, etc).

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I've read everyones' replies, but I didn't see INSULIN addressed........and what about family checking their blood

glucose levels? What if the family/ resident can't/won't check the level, or give the insulin? I'm assuming there

would be MAJOR documentation (obviously), and the family accepts responsibility if there are problems?

Now that I think about it, I don't recall any of my residents on insulin going out for extended LOA's. The ones who do go out for day trips, the norm seems to be the family comes in right after the BS is to be checked and any insulin given and the meal is eaten, they ask when the next one is due and the patient is back in time for the next check.

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Specializes in Gerontology, Med surg, Home Health.

You actually send out an entire card of a narcotic because popping out one or two would be considered dispensing????

We have pill bottles and labels for this. The family gets only enough medication for the time the resident is out of the building. We only give them scheduled medications never PRNs.

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