Sample Drugs

peaceful · Jan 7, 2005

Sample drugs are an excellent way to save money. Totally legal as long as there is a current prescription by a prescribing professional in place for the person you are giving samples to. Of course one can not just give away samples to anyone without a prescription. Not sure why you would think this is a problem? Most medical facilities, psych hospitals, communtiy psych facilities, correctional facilities use sample drugs. Some problems i find is the lot of meds can be expired and then that becomes an issue when addressing the money issue. Now if you are talking about experimental drugs rather than sample drugs then that is a whole another story...

Does anyone use sample drugs in their jails in order to save money? I have a Psych doctor who is insisting on bringing in sample medications for inmates because it will "save the county money." I have a pretty good understanding of the laws and regulations regarding sample drugs in an outpatient clinic setting, where you are giving samples to patients for home use. I am not clear on their use in a correctional facility.

fiestynurse · Jan 8, 2005

The use of sample drugs in California is spelled out in the Business and Professional Code, the Health and Safety Code, and the Nurse Practice Act. It requires securing and logging samples to prevent unwanted access. Providers Must document the dispensation of samples in the medical records and label the sample with patient's name and prescribing information. The samples cannot be repackaged. Records need to be maintained with lot numbers so patients can be contacted in the event of a recall or later-discovered interaction warning.

With all the bad press about drug safety and the significant risks associated with the use of drug samples many facilities have considered eliminating the practice.

peaceful · Jan 8, 2005

Yes you are correct, sample medications must be handled exactly like regular medications, securing, logging, documentation, can not be repackaged, all needs to be professionally handled like any drugs.

The use of sample drugs in California is spelled out in the Business and Professional Code, the Health and Safety Code, and the Nurse Practice Act. It requires securing and logging samples to prevent unwanted access. Providers Must document the dispensation of samples in the medical records and label the sample with patient's name and prescribing information. The samples cannot be repackaged. Records need to be maintained with lot numbers so patients can be contacted in the event of a recall or later-discovered interaction warning.
With all the bad press about drug safety and the significant risks associated with the use of drug samples many facilities have considered eliminating the practice.

fiestynurse · Jan 8, 2005

You don't see any possible risks from having nurses taking medication out of sample boxes and administering them to inmates? It's been my experience, that Providers don't do the proper labeling on the sample and don't document appropriately in the patient's chart that they gave the sample. Drug samples often flow from drug rep to physician without documnentation or accountability. I went into this facility and found samples shoved into a locker with no logs or labels anywhere to be found. The nurses have to be careful because they cross a fine line between dispensing a drug, which they legally can not do, and administering a drug, which is allowed. I think that the use of samples in an inpatient setting has some obvious risks. I have no problem with the doctor handing a sample to a patient in a clinic setting and having that patient take the medication home. My concern in corrections is that nurses get too involved in the handling of these samples and we are so much more liable for the well being of an inmate in regards to drug administration. Sample meds do not meet the first criteria for medical managagement 1) Safety 2) Efficacy 3) Costs. I think that whenever you put costs first you run into problems because safety and efficacy take the back burner. Studies have shown that frequent dispensing of free samples may actually influence the way physicians precribe medication.

Massachusetts law states that a physician may only dispense sample medications in a single dose or in an amount needed for immediate treatment. Other states have similar restrictions on the amount of samples that can be dispensed to a patient. California uses the term "limited quantity," but doesn't really clarify what that means.

Do you give samples in your facility and how is it done. Obviousy, if I am going to allow this, then I will be writing a P&P that meets all the applicable laws and regulations. The Provider will have to be accountable for abiding by that policy, since really most of the liability falls on him. He's the one bringing the medication into the building. Unless I arrange for drug reps to come to the facility and require them to do the inventory, logging and supply the labels.

If the facility is accredited, how does NCCHC feel about the despensing of drug samples?

peaceful · Jan 8, 2005

Fiestynurse,

I have enjoyed talking back and forth on this subject. I am impressed at how much you have researched this subject. Your concern for your patients shine forth in your con's against sample drugs. I agree with you on the dangers of a doctor handling a "sample" drug because it is there rather than the correct med for the patient. The atmosphere where i work no one would do that because we are so pro right drug for the right patient. The BIG reason we give samples is to save money for our patients (homeless). Other times start a patient on a sample drug to see how the patient will tolerate, then give prescription if all goes well. I have a whole locked file cabinet of samples that is utilized on a weekly basis. Yes you are right about samples and P&P (we have a couple paragraphs in our P&P). Now your point about inventory is interesting. Really ideally would be better for the rep, but that is impossible timewise. I handle sample inventory like my other meds. Speaking of, do you know of any good medication inventory software?

When i take med out of the sample package, i look at the right med, right dosage along with the other right's just like any other prescribed med and document all correctly. Otherwise, i would be dispensing medication illegally. I document on the individual MAR under pharmacy i write "stock meds." All my packages are labeled by the manufacture. I would not accept medication packages without a label & expiration date. Shoving samples in a drawer not treating them like any other medication is unacceptable, sounds out of the dark ages. Keep me posted which way your facility goes on this subject. This has been an interesting discussion.

You don't see any possible risks from having nurses taking medication out of sample boxes and administering them to inmates? It's been my experience, that Providers don't do the proper labeling on the sample and don't document appropriately in the patient's chart that they gave the sample. Drug samples often flow from drug rep to physician without documnentation or accountability. I went into this facility and found samples shoved into a locker with no logs or labels anywhere to be found. The nurses have to be careful because they cross a fine line between dispensing a drug, which they legally can not do, and administering a drug, which is allowed. I think that the use of samples in an inpatient setting has some obvious risks. I have no problem with the doctor handing a sample to a patient in a clinic setting and having that patient take the medication home. My concern in corrections is that nurses get too involved in the handling of these samples and we are so much more liable for the well being of an inmate in regards to drug administration. Sample meds do not meet the first criteria for medical managagement 1) Safety 2) Efficacy 3) Costs. I think that whenever you put costs first you run into problems because safety and efficacy take the back burner. Studies have shown that frequent dispensing of free samples may actually influence the way physicians precribe medication.
Massachusetts law states that a physician may only dispense sample medications in a single dose or in an amount needed for immediate treatment. Other states have similar restrictions on the amount of samples that can be dispensed to a patient. California uses the term "limited quantity," but doesn't really clarify what that means.
Do you give samples in your facility and how is it done. Obviousy, if I am going to allow this, then I will be writing a P&P that meets all the applicable laws and regulations. The Provider will have to be accountable for abiding by that policy, since really most of the liability falls on him. He's the one bringing the medication into the building. Unless I arrange for drug reps to come to the facility and require them to do the inventory, logging and supply the labels.
If the facility is accredited, how does NCCHC feel about the despensing of drug samples?

chris_at_lucas_RN, RN · Jan 8, 2005

Does anyone use sample drugs in their jails in order to save money? I have a Psych doctor who is insisting on bringing in sample medications for inmates because it will "save the county money." I have a pretty good understanding of the laws and regulations regarding sample drugs in an outpatient clinic setting, where you are giving samples to patients for home use. I am not clear on their use in a correctional facility.

Sample drugs aren't any different than the drugs that cost money.

This is an unusual doc. Responsible with money that isn't his. Must either be very new, very young, or very good. In any case, s/he would be one I'd like to work with. Personally, I think you are pretty lucky.

Thanks for the thread. Glad to see there are some docs like him/her (especially of the psych genre) out there.

fiestynurse · Jan 8, 2005

It's an older doctor and his motives are political. The facility just privatized. A lot of sabotaging going on. They never mentioned the use of sample drugs in the RFP or when the contract was being negotiated.

chris_at_lucas_RN, RN · Jan 8, 2005

It's an older doctor and his motives are political. The facility just privatized. A lot of sabotaging going on. They never mentioned the use of sample drugs in the RFP or when the contract was being negotiated.

Well, cancel out all my adoration then.

But drugs are drugs and sample drugs are no different from the ones that are overpriced.

fiestynurse · Jan 8, 2005

It's not the drugs themselves that I am worried about. I agree drugs are drugs. But, there is liability involved when you receive drugs via a licensed pharmacy vs. via a drug rep through a physician. I want to make sure that we are abiding by the drug dispensing laws. Pharmacists and Physicians can dispense the prescribed drug. A nurse can only administer drugs. Dispensing involves the labeling of the drug bottle or box with the patients name and instructions on how to take the drug. It also involves teaching them about the side effects, etc. Samples can not be added to the stock medication that you get from the pharmacist. Samples can not go directly from the drug rep to the patient, without being properly dispensed by a Pharmacist or Physician.

peaceful · Jan 8, 2005

I am required by our P&P to teach side effects and document teaching, also signed medication consent form which lists in god awful detail all side effects. Must also write patient's name on box of samples. I do all that you list below, EXCEPT prescribe the drug. Still not understanding the alarm over this subject.

It's not the drugs themselves that I am worried about. I agree drugs are drugs. But, there is liability involved when you receive drugs via a licensed pharmacy vs. via a drug rep through a physician. I want to make sure that we are abiding by the drug dispensing laws. Pharmacists and Physicians can dispense the prescribed drug. A nurse can only administer drugs. Dispensing involves the labeling of the drug bottle or box with the patients name and instructions on how to take the drug. It also involves teaching them about the side effects, etc. Samples can not be added to the stock medication that you get from the pharmacist. Samples can not go directly from the drug rep to the patient, without being properly dispensed by a Pharmacist or Physician.

fiestynurse · Jan 8, 2005

I don't know what state you practice in, but you are dispensing. You are acting as a Pharmacist in the handling of this sample drug. Nurses can not dispense. In most states this violates the Nurse Practice Act. You are preparing the medication for administration within your facility.