Ok to dispose of scheduled drugs in office?

[SCPA]

For example a pt RTC stating they cannot tolerate the tylenol 3 you prescribed them yesterday d/t itching or whatever s/e. You'd like to Rx them something else, maybe ultram.  Is it kosher to dump the pills in the sharps box (with pt and nurse as witness) so you can feel comfortable about Rx-ing them another controlled for pain? 

[EMEDPA]

I have seen this done, however, you need to be very careful to make sure they are actually giving you t3 to dispose of and not excedrin or some other otc med that looks like t3....

[primadonna22274]

Some states have very specific laws on who can waste controlled substances and how they must be wasted. From a risk management perspective I think it makes sense to ask your friendly neighborhood pharmacist and follow suit.

 

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[Joe1968]

when I worked in Pain management, the patient have to bring the pills which we identify, and yes I identify the pills using the lot number imprinted on it, I even at one point called the pharmacy for which they acquired the pills from to make sure it is the right lot number if I'm suspicious just to be on the safe side.

 

I never touch them , the staff will catalog the pills and count them in front of the patient and both patient and staff signed a form stating the dosage and the amount of pills, it doesn't matter whether it is a narcotics, muscle relaxer or NSAIDS. we then destroy the pills in a ziplock bag using bleach and water then dispose in the sharp box.

 

All this are done in front of the patient, the staff and myself as a witness.

[rev ronin]

Around here, all the police stations have locked drop boxes.  You are not law enforcement, and I would be VERY VERY VERY hesitant to accept a controlled substance in transfer, even if you were the one who prescribed it, even for the purpose of disposal, without specific legal guidance.

[SCPA]

Great points everyone. I totally agree with what most of you are saying -- even with the best intent , the liability is sky high.  

 

So in the example I gave, would you recommend prescribing another narc and not worrying about the old script they cannot tolerate?
Telling pt to drop the prescription off with law enforcement or pharmacist would be ideal, but how can we be sure they will or did do this? 

 

I guess ultimately if you look them up and they have no hx of drug seeking behavior it shouldn't really be a problem to Rx them an additional script for a situation that requires opiate-level analgesia. Agreed?  

[rev ronin]

I guess ultimately if you look them up and they have no hx of drug seeking behavior it shouldn't really be a problem to Rx them an additional script for a situation that requires opiate-level analgesia. Agreed?  

... Especially not if they started with T3's.

 

I'd make sure and run a PMP query.  No one gets narcotics from me without photo ID, a query, and an appropriate in-office drug screen in the last year, and a signed agreement if they have chronic needs.  All this gets explained compassionately, about how it's protecting them as well as me, but it's pretty inflexible.

[ventana]

I have done this numerous times before,Verifying pills, with a witness for the entire count and destruction.

 

On thinking about this further, I would see no reason why the pharmacy could not take them back, placing the liability on them to verify the correct medicine, prior to giving the replacement medicine. They certainly can dispose of.

 

Honestly I don't think there's much personal liability here as long as you are documenting correctly, and truly disposing of in front of numerous people. That does mean that the actual act of getting rid of them, i.e. filling the pill bottle with bleach has to be witnessed. There is however liability to practice And therefore the administrator should likely be involved.

[rev ronin]

[...] There is however liability to practice And therefore the administrator should likely be involved.

So why do it, then?  You aren't getting paid to do it.  I'm all for helping out patients with simple stuff as much as the next guy, but why take on practice liability without any upside?

[Guest Paula]

My office will not let us take any prescription drug back if a patient brings one in.  I did not get a clear answer as to why as it was the MA's who told me.  

[ventana]

I have done this numerous times before,Verifying pills, with a witness for the entire count and destruction.

 

On thinking about this further, I would see no reason why the pharmacy could not take them back, placing the liability on them to verify the correct medicine, prior to giving the replacement medicine. They certainly can dispose of.

 

Honestly I don't think there's much personal liability here as long as you are documenting correctly, and truly disposing of in front of numerous people. That does mean that the actual act of getting rid of them, i.e. filling the pill bottle with bleach has to be witnessed. There is however liability to practice And therefore the administrator should likely be involved.

 

So why do it, then?  You aren't getting paid to do it.  I'm all for helping out patients with simple stuff as much as the next guy, but why take on practice liability without any upside?

 

 

I have done this numerous times before,Verifying pills, with a witness for the entire count and destruction.

 

On thinking about this further, I would see no reason why the pharmacy could not take them back, placing the liability on them to verify the correct medicine, prior to giving the replacement medicine. They certainly can dispose of.

 

Honestly I don't think there's much personal liability here as long as you are documenting correctly, and truly disposing of in front of numerous people. That does mean that the actual act of getting rid of them, i.e. filling the pill bottle with bleach has to be witnessed. There is however liability to practice And therefore the administrator should likely be involved.

 

 

 

 

hence why I was saying get the admin involved, it is more their issue.  In the "big utopia in the sky" it is the right thing to do..... but we live in reality...

[Glorious_Ignoramus]

I'm not a PA; the hospital at which I work has a very strict policy on med returns...no way, not under any circumstances.  Twice per year some pharmacists, accompanied by the local PD, come by and set up unused drug collection points.  Some patients become upset because the med in question was sent by mistake and they demand we rectify it by taking the pills back, but as mentioned this is an imperative sent from the top, no wiggle room at all.  We tell them to stash the meds in a cupboard at home wait it out until the next collection.