Long-Term Care Survey Alert

Environmental concerns up the ante for managing this common task.

A patient dies or goes to another care facility, leaving his controlled medications behind. What you do next could cause a compliance headache on a couple of fronts.

The bottom line: You have to follow state law requirements for disposing of the medication, and these may differ from state to state. "Some states require two nurses to destroy the medication," says Al Barber, a director of pharmacy services for Golden Living Pharmacy Services at Golden Living. "Other states require a nurse and a pharmacist to do so. In the latter case, the facility has to store the medications until the pharmacist comes in, which may be only once a month. The drugs have to be secured with a double lock," adds Barber. (He doesn't count the director of nursing's office door as a lock because her door is often open.)

Disposing of the drugs isn't just a matter of whom -- but also how.

"Nursing home staff used to flush the medications," says Barber. "But a lot of states and local Environmental  Protection Agencies are advisingagainst that or don't allow it."

Example: "Illinois passed legislation that starting January 2010 will prohibit nursing facilities from flushing any unused medications," says Carla Saxton McSpadden, RPh, CGP, with the  American Society of Consultant Pharmacists (ASCP). ASCP surveyed pharmacists in 2009 and found they were disposing of unused medications in various ways, she reports. "Some were mixing all prescription drugs, including controlled and non-controlled ones, with kitty litter, etc., and disposing of them in plastic bags that go in the landfill."

Using machines that provide dispensing on demand for the majority of commonly used medications can help reduce the need to dispose of drugs. "The pharmacy reviews the medication orders for appropriateness and so forth before authorizing access to the medication in the dispensing system," says McSpadden.

Once the medication is "released," the nurse can access that medication"or all 9 a.m. medications, for example, on demand," she adds. "So there's very little waste." The machines can be prohibitively expensive for facilities, notes McSpadden, but they also provide a significant return on investment over time. Some facilities "may start out using the machines as an emergency box and take it from there," she says.

Resource: Read about how Western Pennsylvania senior care providers, including nursing homes, plan to use the dispensing machines to realize major savings: http://pittsburgh.bizjournals.com/pittsburgh/stories/2009/10/05/story5.html.