Patient's Own Narcotics in Hospital Setting

[Sparda29]

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How do you guys handle this kind of situation? We have a guy here who is only gonna be a here a few days recovering from orthopedic surgery. One of his home meds is Adderall XR, which is non formulary here. We only carry generic Ritalin and we're trying to even get that off formulary.

Usually, we allow patients to take their own medications as long as we've IDed them and they are not controlled substances. How do you guys do it when it's a controlled substance or do you even allow it? Patient just has to suck it up for a few days?

 

[VA Hopeful Dr]

How do you guys handle this kind of situation? We have a guy here who is only gonna be a here a few days recovering from orthopedic surgery. One of his home meds is Adderall XR, which is non formulary here. We only carry generic Ritalin and we're trying to even get that off formulary.

Usually, we allow patients to take their own medications as long as we've IDed them and they are not controlled substances. How do you guys do it when it's a controlled substance or do you even allow it? Patient just has to suck it up for a few days?

I can't think of why he couldn't go a few days without his adderall.

 

[smercer]

We verify the Drug/Script match up for the patient. Then we lock up the med in a section of the narc vault used for Pt Home Meds. When a dose is needed we will dispense 1 dose from the bottle and label a bag with the drug/str/pt info. We keep 1 form that tracks the starting count and we deduct each dose with a signature of RPH and RN. After Pt is DC the nurse returns to the pharmacy and signs out the meds for the patient.

To my knowledge you do not need anything special to do this. Pretty much just need a secure location to keep the meds and a form to track doses that are dispensed.

Kind of odd that this is just now an issue. We allow Pts to use their own meds at any time, assuming we can properly verify the med/script are valid. Would sound kind of illegal to me, if you force them to purchase your meds, when they are providing an equivalent med that they have a script for.

 

[Sparda29]

We verify the Drug/Script match up for the patient. Then we lock up the med in a section of the narc vault used for Pt Home Meds. When a dose is needed we will dispense 1 dose from the bottle and label a bag with the drug/str/pt info. We keep 1 form that tracks the starting count and we deduct each dose with a signature of RPH and RN. After Pt is DC the nurse returns to the pharmacy and signs out the meds for the patient.

To my knowledge you do not need anything special to do this. Pretty much just need a secure location to keep the meds and a form to track doses that are dispensed.

Kind of odd that this is just now an issue. We allow Pts to use their own meds at any time, assuming we can properly verify the med/script are valid. Would sound kind of illegal to me, if you force them to purchase your meds, when they are providing an equivalent med that they have a script for.

Honestly, we prefer if patients don't use any home medications at all. There is usually always some issue upon discharge that the meds get lost or something. Once we ID them, we send the entire bottle to the floor and it's the nurses responsibility to keep it safe.

What if the patient's family member administers it "without our knowledge"?

 

[zelman]

What if the patient's family member administers it "without our knowledge"?

Assuming you're implying that this would be a *nudge* *nudge* *wink* *wink* situation, it might be fine for a given situation. However, it's a terrible precedent to set (officially or otherwise) given the potential for drug interactions and duplicate therapies.

If it's legit being "snuck in"...meh. Whatcha gonna do? Cavity search everyone coming in the front door? There is no reasonable course of action, so take none.

 

[CritCare PharmD]

How do you guys do it when it's a controlled substance or do you even allow it?

We have a drawer in Pyxis that is specific for patient's own controlled meds. When accessing the draw, the user will be required to enter the current quantity of the medication. We also put an inventory page with the med, where the nurse will write the current quantity and how many tablets were given to the patient. All of the other processes are the same as a non-controlled home medication.

Patient just has to suck it up for a few days?

For some C-II's, this might not be an option. Also, in an environment where patient satisfaction is tied to hospital reimbursement, I think having a hospital policy for this type of situation is important.

Honestly, we prefer if patients don't use any home medications at all.

Agreed -- it's better to use hospital inventory whenever possible for med errors and for hospital liability of lost home medications.

What if the patient's family member administers it "without our knowledge"?

Seems like a great work-around, but really not appropriate because the medication won't be on the patient's MAR -- thus, no drug interaction checking, providers may not be aware patient is taking med, no documentation medication was/wasn't given, etc.

 

[rph3664]

We verify the Drug/Script match up for the patient. Then we lock up the med in a section of the narc vault used for Pt Home Meds. When a dose is needed we will dispense 1 dose from the bottle and label a bag with the drug/str/pt info. We keep 1 form that tracks the starting count and we deduct each dose with a signature of RPH and RN. After Pt is DC the nurse returns to the pharmacy and signs out the meds for the patient.

To my knowledge you do not need anything special to do this. Pretty much just need a secure location to keep the meds and a form to track doses that are dispensed.

Kind of odd that this is just now an issue. We allow Pts to use their own meds at any time, assuming we can properly verify the med/script are valid. Would sound kind of illegal to me, if you force them to purchase your meds, when they are providing an equivalent med that they have a script for.

The hospitals that I worked at followed similar procedures, and their policy was that home meds were allowed only if we did not have that drug in stock.

This patient may have narcolepsy or some other situation where going off it cold turkey could be extremely dangerous.

 

[group_theory]

One thing to keep in mind is that if the patient is admitted under observation status instead of full admission status (did not meet some arbitrary insurance guidelines for full admission), many insurance companies and even Medicare will not pay for medications received during their stay, since in the eyes of CMS and many insurance companies, observation status is considered the same as outpatient services. The patient will be saddled with the bill for medications dispensed during their brief stay.

As Medicare tighten the rules for "admission" criteria, and hospitals are starting to do chart review to catch these "obs vs full admit" to avoid insurance companies rejecting claims,expect to see a higher percentage of Obs patients.

So wanting to take their home meds makes practical financial sense to them. And as you are fully aware, a lot of the public are on control substances. Your orthopedic patient may be recovering from surgery, but he may not be a "fully admitted" patient per guidelines and run the risk of getting charged by the hospital for every medication administered to him.

(One reason physicians have daily meetings with the resource utilization nurses, to determine who meets criteria for observation, who to convert from obs to full admit, who to admit as an extended outpatient surgery stay, etc. it is to properly classify admitted patients into the appropriate category based on criterial set by Medicare or insurance)

http://usatoday30.usatoday.com/mone...n-be-expensive-in-observation-care/54646378/1

http://www.aarp.org/health/medicare...npatient-vs-outpatient-under-observation.html