What does your hospice do when a home patient revokes from hospice service in regards to leaving prescription narcotics in the home? Mine is arguing this point.
team A says : we have to go into the home and destroy the patients prescription narcotics (that hospice provided) because they (the hospice) could be held liable if the patient mismanages the meds he could hold the hospice liable because if they them in the home. They go on to argue that when a patient revokes service, hospice has to D/C the care plan, meds ect..since they have d/c'd the meds, hospice is responsible for their destruction.
team b says: we cant go into a patients home and take prescription narcotic in their name and destroy them. Besides being mean and vindictive, this group believes it is unethical to require a patient to allow you to destroy their narcotic (which are usually for pain!)
what do you guys do out in your homecare hospice settings when a patient revokes? has anyone EVER heard of going in to destroy narcotics?
Although our MD has to sign for us to have the comfort pak in the home (from HP) we are suppose to get another order to use any of the medications in the kit. If we start using a med from the kit we get them then add it to their routine meds; and order it PRN.
Example: A pt is having moderate to severe aggitation in the middle of the night and the on call staff starts him on Ativan from the comfort pak, per MD orders she obtains. The RN Case Manager arrives the next day and he has had two doses which are working well. The medication would be added to his routine med list and a prescription bottle of it ordered. Two months later the pt revokes. The nurse would destroy the Comfort pak; but the pt still has his Ativan b/c it was ordered as a routine med AND in collaborating with the physician who will take care of the pt after revocation; usually due to going to hospital they would be supplied with a medication list which has the Ativan on it. So, the pt is not without.
It is in the patient's name. The comfort pak includes: Ativan, Morphine, Haldol, Atropine, Compazine, Tylenol supp.
On the kit it states DO NOT OPEN UNLESS A MD OR NURSE TELLS YOU TO. Therefore, once they are off service they will not have a nurse/md telling them to do anything with it.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Just for the record...when an emergency kit is delivered to the patient, that kit is signed out for that patient specifically...it is as much theirs as the other meds provided by hospice. After the ER kit is delivered it should be opened and all meds labeled with the patient name and date.
I can see the problem with the E-kit/comfort pak ... the stock is there for emergencies and the pt does not necessarily have a valid MD order/Rx for the meds. I agree with removing it.
However, prescribed meds belong to the pt, IMHO and hospice staff has no more business removing them than a home health nurse has removing cardiac meds (for instance) when a pt is discharged from home health.
All I can tell you is that is our company's policy; whether it is right or wrong I don't know. I can see both sides of the argument. We open the kit to explain all the meds to the pt, but they are already labeled with their name on it. We then close and seal it and it is to remain sealed until we receive a future MD order and instruct the family regarding this.
This brings up a good point though about the legalities and ethics. Anyone know the legal laws regarding this topic? Where could I look? Do you think it is by state?
volsfan
39 Posts
Although our MD has to sign for us to have the comfort pak in the home (from HP) we are suppose to get another order to use any of the medications in the kit. If we start using a med from the kit we get them then add it to their routine meds; and order it PRN.
Example: A pt is having moderate to severe aggitation in the middle of the night and the on call staff starts him on Ativan from the comfort pak, per MD orders she obtains. The RN Case Manager arrives the next day and he has had two doses which are working well. The medication would be added to his routine med list and a prescription bottle of it ordered. Two months later the pt revokes. The nurse would destroy the Comfort pak; but the pt still has his Ativan b/c it was ordered as a routine med AND in collaborating with the physician who will take care of the pt after revocation; usually due to going to hospital they would be supplied with a medication list which has the Ativan on it. So, the pt is not without.
It is in the patient's name. The comfort pak includes: Ativan, Morphine, Haldol, Atropine, Compazine, Tylenol supp.
On the kit it states DO NOT OPEN UNLESS A MD OR NURSE TELLS YOU TO. Therefore, once they are off service they will not have a nurse/md telling them to do anything with it.