Hospice Dealing with New Rules Regarding Opioids

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Billie Whitehurst By Billie Whitehurst, MS, RN 
Executive Vice President, Extended Care and Care Operations, Change Healthcare
New Hospice Rules for Opioids

The opioid crisis is forcing many hospices to reexamine their policies toward the prescribing and handling of controlled prescriptions, as well as staying current with laws in their states.

Comfort Kits issued to hospice patients often contain controlled substances or prescriptions for them, recognizing the common goal of keeping patients as pain-free as possible. However, stories abound of family members, caregivers, and neighbors stealing a patient’s medications, often with agonizing consequences for patients. Kaiser Health News described several instances in an August report on the opioid crisis.

As a result of opioid and controlled substance abuse, nearly a dozen states have adopted prescription drug monitoring programs (PDMP) and others have tightened rules around prescriptions for controlled substances. Hospices should ensure their policies are consistent with state and federal rules while keeping patient care front and center.

Overdose deaths on the rise

According to the Centers for Disease Control and Prevention, provisional drug overdose deaths topped 64,000 in 2016, a 21% increase over the previous year. More than 34,000 of those deaths were attributed to opioids. Increased emphasis on the issue led President Donald Trump to declare a national public health emergency to deal with the opioid problem.

States also have been active, further restricting who can prescribe controlled substances, how much can be prescribed, and for how long. However, many states, including Pennsylvania, specifically carve out exemptions for pain associated with a cancer diagnosis or palliative care. According to Pennsylvania’s law passed in November 2016, a physician can prescribe for more than seven days for cancer and palliative care after documenting “in the patient’s medical record that a non-opioid alternative was not appropriate under the circumstances.”

The Department of Health and Human Services has clear-cut guidelines for how controlled substances should be handled in a patient’s home. The rule states that hospices “must have written policies and procedures for the management and disposal of controlled drugs in the patient’s home. At the time when controlled drugs are first ordered the hospice must:

  • Provide a copy of the hospice written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family;
  • Discuss the hospice policies and procedures for managing the safe use and disposal of controlled drugs with the patient or representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe use and disposal of controlled drugs; and
  • Document in the patient’s clinical record that the written policies and procedures for managing controlled drugs was provided and discussed.”

Controlled drugs used in hospice inpatient settings must be disposed of following state and federal guidelines and the hospice’s own rules. Accurate records must be maintained for the “receipt and disposition of all controlled drugs.”

Controlled substances in the home

For hospices that use the medication profile in our Hospice Advisor™, we advise only entering medications that are physically in the home. In cases where the Comfort Kit has not been administered, for example, we provide an on-hold designation to signify that the kit has not been administered.

The Federal Drug Administration recommends disposing of drugs by mixing uncrushed medications with some unpalatable substance, such as kitty litter, dirt or used coffee grounds, then disposing of them in the household trash. Ensure your agency reviews and keeps all policy and procedures current.

Hospices are long-standing patient advocates. We must do our part to help ensure our patients are safe and receive the medications they need for symptom control.

The information provided in this Change Healthcare site is provided to you for informational purposes only. The materials are general in nature, are not offered to you as advice on a particular matter, and should not be relied on as such. Use of this website does not constitute a legal contract or consulting relationship between Change Healthcare and you.

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