When should a patient Narcotics be destroyed

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So a nurse decides to steal a discharge and decease patient Narcotics out that lock box. When should the DON have removed them? Is there a time frame for this to prevent these things from happening?

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https://www.nhpco.org/sites/default/files/public/regulatory/DEA_Drug_Disposal.pdf

1. How should a hospice handle drug disposal in the home?

(This answer is taken from the DEA discussion on the issue in the final rule in its entirety.)

Detail on Issue: The DEA received a number of comments regarding the lack of provisions for hospice and other homecare programs to dispose of controlled substances on behalf of patients. According to the commenters, many hospices have written policies and procedures in place for the management and disposal of controlled substances in the patient's home. Given the available options for ultimate user disposal, commenters expressed concern that hospices may no longer be able to assist families in disposing of a deceased patient's drugs. Commenters suggested that the DEA allow hospice staff to dispose of a decedent's controlled substances by sewering or landfill disposal.

A: The DEA appreciates the difficulties facing home hospice staff with regard to the disposal of pharmaceutical controlled substances. The Disposal Act provides that "if a person dies while lawfully in possession of a controlled substance for personal use, any person lawfully entitled to dispose of the decedent's property may deliver the controlled substance to another person for the purpose of disposal under the same conditions as provided" for ultimate users. 21 U.S.C. 822(g)(4). Otherwise, home hospice and homecare personnel are not authorized to receive pharmaceutical controlled substances from ultimate users for the purpose of disposal. In addition, an ultimate user includes "a person who has lawfully obtained, and possesses, a controlled substance for his own use or for the use of a member of his household." 21 U.S.C. 802(27). Accordingly, a member of the hospice patient's household may dispose of the patient's pharmaceutical controlled substances, but the home hospice or homecare provider cannot do so unless otherwise authorized by law (for example, under state law) to dispose of the decedent's personal property. This rule provides a number of options for ultimate users and persons lawfully entitled to dispose of a deceased ultimate user's property to safely and securely dispose of pharmaceutical controlled substances, yet the DEA does not require ultimate users to utilize these options. However, it is unlawful for ultimate users to transfer pharmaceutical controlled substances to unauthorized persons, and it is unlawful for unauthorized persons to receive such substances. It is also unlawful for any person to possess a controlled substance unless authorized to do so under the CSA (i.e., an National Hospice and Palliative Care Organization, © October 2014. 3 | Page ultimate user, an entity registered with the DEA, or an entity exempt from registration with the DEA). 21 U.S.C. 844(a). Home hospice and other homecare providers are encouraged to assist their patients, and their patients' families, in disposing of pharmaceutical controlled substances in accordance with the CSA and its implementing regulations. While education is paramount, home healthcare agencies are also encouraged to partner with authorized collectors to promote or jointly conduct mail-back programs.

2. Can a hospice employee utilize a LTCF's collection receptacle for disposal of controlled substances for a LTCF resident who is also a patient of the hospice?

A: No. Congress specifically allowed the Attorney General to consider permitting LTCFs to dispose of pharmaceutical controlled substances on behalf of LTCF residents. This allowance did not extend to other persons who are simply attending to a person who is resident of the LTCF. As such, a hospice employee is not authorized to dispose of pharmaceutical controlled substances on behalf of a

person who resides or has resided at a LTCF. However, LTCF employees may do so on behalf of ultimate users who reside, or have resided, at the LTCF.

3. Is a hospice facility considered a Long Term Care Facility (LTCF)?

A: LTCF is defined at § 1300.01(b) and "means a nursing home, retirement care, mental care or other facility or institution which provides extended health care to resident patients."

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So a nurse decides to steal a discharge and decease patient Narcotics out that lock box. When should the DON have removed them? Is there a time frame for this to prevent these things from happening?

I will be the first to reply:

What?

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Specializes in ICU.

Uh, if a nurse stole narcotics from a deceased patient they need to be reported to the board of nursing. The DON of your facility has no responsibility to rapidly remove narcotics to "prevent these things from happening". This falls under the code of ethics attached to your license. Diversion is a big deal, whether the patient is alive or not. This nurse will likely have sanctions placed on their license at best and have to participate in a rehab program, or lose their license entirely otherwise.

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Uh, if a nurse stole narcotics from a deceased patient they need to be reported to the board of nursing. The DON of your facility has no responsibility to rapidly remove narcotics to "prevent these things from happening". This falls under the code of ethics attached to your license. Diversion is a big deal, whether the patient is alive or not. This nurse will likely have sanctions placed on their license at best and have to participate in a rehab program, or lose their license entirely otherwise.

Where I think OP is going is the same line of logic as, "If you locked your doors you wouldn't be robbed" or the always popular, "If you just dressed more modest you wouldn't be raped."

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Someone wants a lot of people to get in trouble for this. People love it when other people get in trouble.

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I would think destroying them as soon as the patient's body has left the facility or within a few hours would be the best way.

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In the SNF where I work, it is customary to dispose of the narcotics WITH the on call hospice nurse. When the resident passes away the hospice provider is contacted. When she/he arrives they assist with the preparation of the body, any family present at bedside, phone calls to funeral home and/or other family - and then we both dispose of medications as this needs to be co-signed by a witness to the destruction.

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Specializes in Neuro, Telemetry.

When I worked in a SNF, the ADON would sometimes dispose of narcs the same day. And sometimes take weeks. Each time those keys are passed, the oncoming nurse is responsible for all meds in that cart or in the med room lock box. We would count ALL narcs. Even the ines set for disposal to ensure correct counts until the ADON would come to dispose.

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