Leftover medications

Ever tossed expired pills in the trash can? Or flushed unused meds down the toilet? The new Drug Enforcement Agency (DEA) rules on controlled substance disposal have been in force for two years, yet you might be surprised how many skilled nursing facilities (SNFs) are still using the “flush method” for drug disposal.

Facilities that don’t have clear policies and procedures for reclaiming unused portions of medication and disposing of expired drugs are risking inventory loss, or worse. Those that don’t have procedures to deter diversion, theft and misuse are skating on even thinner ice, explains David Tusa, president and CEO of Sharps Compliance Inc., a Houston-based manufacturer of medication collection systems.

“I think most administrators would probably be very surprised by how things are being done in their facilities,” Tusa says. “If you don’t make it part of your policies, it’s not going to get done.”

The 2014 DEA rule suggests three main disposal avenues for unwanted medications: Drug take-back programs, mail-back programs and onsite collection receptacles. Much of the final rule is focused on nursing homes and hospice, two settings that use controlled substances for pain management but whose environments are not as regimented as hospitals.

Secure collection receptacles, lock-boxes hosted by a registered pharmacy location and mail-back envelopes are all ways to train staff and families to handle unused and expired medications properly. “The one client that has really embraced receptacles and mail-back envelopes is the Veterans Administration, especially since 2015,” Tusa says. “The patients don’t have to go anywhere to drop off old medication, they can just mail it from home.”

Hospice care is a hotspot for trouble, both because of the level of pain medication and the ease of diversion, Tusa adds. “Hospice is a huge problem. Some grandkids dive for the unused meds once grandma dies.”

Medication managed

  • Assess the facility’s current practices for compliance and consistency.
  • Policies and procedures should be the same on weekends as they are on weekdays, and the same from day shift to night shift.
  • Pay special attention to documentation protocols for controlled substances.
  • Provide compliance training for all clinical staff, including nurses, medication aides and direct-care workers.
  • Create policies to account for medications as a resident changes care locations, such as moving from SNF care to hospice.

Technology can provide a safe, convenient way for nursing staffs to destroy medications onsite each day rather than stockpiling them for disposal or using homemade methods such as mixing medications with kitty litter, says Sherry Day, the 20-year veteran nurse who developed Drug Buster, a charcoal-based medication disposal system. “I’ve seen health systems stockpile unused medication in 2×2 boxes for nearly 100 patients, and home care patients store prescription drugs in Tupperware and suitcases,” Day said in a Medline article. “It would take nearly a week to dispose of that many drugs. To ensure the process was cost and time effective, nurses took shortcuts, such as blending the drugs and sending medicinal ‘dust’ into the air.” Instead, the Drug Buster system converts pills, patches and liquids into a chemically inactive “slurry” that can be tossed straight into the trash.

When it comes to assuring compliance with the rules, the nursing team and the pharmacy need to be involved, but accountability ultimately rests on the administrator’s desk, Tusa says. “The team approach is best, but you need one of the top administrators to be in the center of the discussion and take responsibility for the assessment and the follow through.”

The American Medical Association (AMA), at its annual meeting this week in Chicago, called on the pharmaceutical industry to fund a program for disposing unwanted medications as hazardous waste. An estimated 30 and 80 percent of patients don’t finish prescriptions for common medication, including pain medication, steroids and hormones, many of which end up in rivers, streams and groundwater, noted an AMA policy announcement sent by email.

Other types of drugs are taken by other people before they can be disposed of properly, said AMA President-Elect David O. Barbe, MD, at the association’s annual meeting this week in Chicago. “Many of these unused medications, most notably opioids, are diverted and used by someone other than the patient. Manufacturers should be stewards of their products throughout their lifecycle and provide this critical service to patients and our environment.”


Topics: Clinical Leadership , Risk Management , Uncategorized