Home hospice provides terminally ill patients with a dignified experience in the comforts of their own homes. Nurses who work for home hospice agencies are knowledgeable professionals skilled in helping patients and their families understand complex medication regimens, including advising them on how to store and safely dispose of them.
However, a recent US Government Accountability Office report found many hospice medications, particularly opioids, end up in the wrong hands. This is why the federal government has endorsed the hospice industry as a key player in fighting the opioid epidemic.
Federal Drug Disposal Regulations & Recommendations Have Changed
The regulatory process has been a bit complicated:
- Before 2014, hospices nationwide were either assisting with or directly disposing of their patients’ controlled substances (“controls”).
- In 2014, the Final Rule on the Controlled Substances Act (CSA) prohibited hospices from disposing or assisting with the disposal of patients’ controls unless a state law granted them that authority.
- After 2014, several states began to pass laws granting hospices the authority to assist and dispose.
- In October 2018, the growing opioid epidemic led to The Support for Patients and Communities Act, which encourages states to legally authorize certain hospice staff to dispose of patients’ controls.
The requirements in the Support for Patients and Communities Act are only optional, so hospices must still follow the rules of their state. Hospice regulations, pharmacy regulations, and nurse practice laws vary state to state. So, in states without drug disposal requirements for hospices, the Support for Patients and Communities Act makes several recommendations:
- RNs, LPNs, NPs, physicians, and PAs employed by the hospice or working under an arrangement for qualified hospices are authorized to dispose of patients’ lawfully dispensed controls following death, expiration, or a change in the plan of care that no longer includes the medication(s).
- Hospice staff are required to train and document the training of any nurses, physicians, or PAs disposing of controls in a secure and responsible manner to discourage abuse, misuse, or diversion.
- The hospice must have written policies and procedures regarding the disposal of controls. They must provide, effectively communicate, and document the communication of these policies and procedures to the patient, patient representative, and family when controls are first ordered (these provisions are dually required under Medicare’s Conditions of Participation for Hospices §418.106).
- After disposal by the hospice staff/assistance with disposal, the staff must document in the patient’s clinical record the type of control, dosage, route of administration, and quantity so disposed as well as the time, date, and manner of disposal.
Hospice Providers & Patients Have Options for Safe Medication Disposal
While most hospice nurses worry about their patients’ unused medications, one study found that only about 16% were trained on safe disposal, and one third were not familiar with the Centers for Medicare & Medicaid Services’ disposal requirements.
The CSA and the Environmental Protection Agency (EPA) discourage the flushing or sewering of medications, which can harm drinking water, lakes, and rivers. And decomposition pouches designed for the trash are not scientifically proven to break down the chemicals in the medications. Many municipalities also prohibit trash disposal of medications because of their toxicity to the environment and potential for diversion.
Both the Drug Enforcement Agency (DEA) and the EPA recommend take-back programs, secure collection receptacles, and mail-back envelopes as preferred disposal methods for opioids and other pharmaceutical wastes. While these solutions are commonly found within local pharmacies and law enforcement, many hospices find the in-home convenience of mail-back envelopes a perfect fit for their patients’ needs.
Sharps Compliance’s TakeAway Medication Recovery System Envelopes are designed according to the DEA’s strict standards to ensure a convenient, discreet, compliant means of removing unwanted drugs from the home. Once filled and sealed by the patient or their legal representative, envelope contents are concealed from view, mailed to our DEA-licensed incinerator, and burned to ash, forever removed from abuse, poisoning, and the natural environment.
Regardless of what disposal method their patients use, hospice agencies should periodically review their written policies on unused medications to ensure nursing practices are in full compliance with federal, state, and local regulations.