Medicare Compliance & Reimbursement

Scenario: Your hospice patient dies soon after you refill his prescribed medications. Leaving them in the home opens the door to potential drug diversion or accidental poisonings. You can eliminate this risk by returning for the medication, right?

Not so fast: While leaving the meds could be dangerous getting them out of the house requires a mixture of regulatory and legal know-how, as well as awareness of environmental concerns.Use this advice to protect your patients' family members from harm while also staying within regulatory lines.

Reality: Just because you know a deceased patient's scheduled meds are still in his home does not mean you have the right to come in and collect them. "Technically, once the drugs are prescribed and in the patient's home, they are the patient's property," says Janet Neigh, VP for hospice with the National Association for Home Care & Hospice.

Best: Don't leave this potential problem to fester -- address it from the beginning with clear policies and procedures for "disposing of controlled substances after a patient's death that include taking an inventory of the drugs that are left in the home and the manner of disposal," says Marie Berliner, an attorney in Austin, Texas.

Make sure you discuss your policies and procedures with both the patient and his family members or housemates when you first begin a relationship. Ask everyone to agree on when and how you'll collect unused drugs after a patient's death, Neigh advises. This way, no one is surprised or upset when the time comes.

Your policies and procedures must comply with state law and regulations. Work with a legal expert to ensure that you don't implement any policy that goes against those rules.

Beware: "More and more locations are passing laws saying you can't flush the drugs in the commode," says Neigh. One alternative is to mix the unused drugs with something undesirable, such as used kitty litter, and then put it in the trash, she notes.

In comments to the Drug Enforcement Administration back in March, the National Hospice & Palliative Care Organization asked what to do about the need for a "drug take back," reports Judi Lund Person, the organization's VP of regulatory and state leadership."Some options discussed include perhaps a mail-back or the family could drop the drugs off at a pharmacy where the drugs are then incinerated," Person relates.

You don't have to be a one-person (or one agency) machine when it comes to drug take-back, says Albert Barber, PharmD, who oversees pharmacy services for a national nursing facility chain based in Ft. Smith, Ark.

Do this: Ask local law or drug enforcement officers to help you create your take-back policies and procedures and educate patients' families. Ask that person to accompany you when you remove medications from a deceased patient's home, Barber suggests. Remember to give family members or housemates a heads up before your take-back team comes knocking.

Another approach: "As an alternative, a nurse and a responsible family member could adulterate the medication and throw it in the trash," Barber adds. Then the nurse would have the family member sign a form confirming that they disposed of the medication.