Destruction of Medications
PDF Version of BQA 05-003 (PDF,
36 KB)
DATE: March 15, 2005 BQA Memo 05-003
TO: Adult Family Homes AFH –
02, Community Based Residential Facilities CBRF –
02,
Residential Care Apartment Complexes RCAC -
02
FROM: Kevin Coughlin, Chief, Assisted Living Section
Via: Cris Ros-Dukler, Director, Bureau of Quality Assurance
ISSUE
Questions have come up about the appropriate times to destroy medications
in assisted living facilities.
RESPONSE
Community-Based Residential Facility (CBRF)
Please refer to BQA memo 00-038 about
destroying controlled substances. The U.S. Drug Enforcement Agency (DEA) does
not oversee assisted living facilities, therefore, the destruction
requirements to contact the DEA, found in Wis. Admin. Code § HFS
83.33(3)(j)1, do not apply.
In addition to controlled substances regulations for CBRFs, § HFS
83.33(3)(j) provides requirements for destroying medications when the facility
has responsibility for controlling and administering those medications. The
requirements stipulate that destruction must occur within 72 hours after any
of the following occurs: (1) the medication is stopped; (2) the resident dies;
(3) the medication expires; (4) medication integrity is lost or compromised;
(5) when a resident is discharged.
Two situations have historically caused problems regarding the destruction
of medications. The first is when a physician holds or stops a medication for
a short time due to a medical procedure or some other clinical reason. Some
facilities have interpreted the "hold medication" order as a stop
and have proceeded to destroy the medication only to find out that the
medication is restarted a few days later. This is costly and unnecessary. When
a medication is placed on a temporary hold, the facility does not have to
destroy the medication within 72 hours. If facility staff feel that the
medication may be restarted, a physician’s order to hold the medication for
30 days should be obtained. Additionally, CBRFs should establish a policy and
procedure to store medications that are on hold separately from medications
currently being used.
The second situation involves the discharge of a resident. Current
regulations require destroying medications when a resident is discharged.
However, the regulations also require discharge planning and making sure that
care is coordinated with the receiving facility. Discharge planning includes
the transfer of a resident’s medications. If the resident is continuing the
medication, then the medications available for that resident may be sent along
with that resident and need not be destroyed. However, if the medications have
actually been discontinued and will not be used, then they need to be
destroyed within 72-hours. The Department recommends that facilities develop a
policy and procedure to address situations where medications are sent with a
discharged resident to a new location. These policies and procedures should
include a way to document and verify which medications were sent with the
discharged resident.
Residential Care Apartment Complexes (RCAC)
An RCAC that is providing medication management to its tenants shall
provide the tenant with information on policies related to medication safety
including the destruction of discontinued medications.
Adult Family Homes (AFH)
An AFH that is assisting residents with medications, including proper
storage, shall have a policy to address storage and destruction of
discontinued medications.
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