By Donielle Tigay Stutland, J.D.
GAO releases a new report detailing best practices of in-home hospice workers’ safe disposal of controlled substances, as well as challenges faced in the disposal of controlled substances following an in-home patient’s death.
The GAO released a report detailing best practices for drug disposal following the death of an in-home hospice patient in compliance with the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), enacted in 2018. The report also details barriers to safe disposal described by hospices and state hospice associations. According to the GAO, when hospice patients die at home, they often leave behind unused controlled substances, which can be diverted and misused by anyone with access (GAO Report, GAO-20-378, April 14, 2020).
The SUPPORT Act allows employees of qualified hospice programs to dispose of unused controlled substances by collecting and destroying the drugs in patients’ homes. The SUPPORT Act also requires GAO to report to Congress each year with information on the law’s impact. To complete the report, GAO interviewed officials from CMS, the Drug Enforcement Administration, three national hospice trade associations, two national nurse trade associations, 11 state hospice associations, and seven hospices. The report describes the disposal practices of selected home hospices, as well as the challenges faced when disposing controlled substances after the death of an in-home patient.
Best practices. The report identified best practices of Medicare-certified hospices, including those selected by GAO for review, which are required by CMS’s Hospice Conditions of Participation, to have written policies and procedures for safe in-home disposal of controlled substances.
Best practices noted in the report include disposal education for patients and their caregivers, conducting drug counts by nurses at every visit to ensure proper amounts of medications remain, the use of lockboxes if diversion is suspected or children are present in a patient’s home, pharmacy cooperation, such as mailing prescriptions or daily medication delivery by pharmacies, and disposal assistance, such as witnesses for disposal and in-home disposal products. Hospices also indicated that documentation by employees of certain tasks is also important for best practices, including documentation if families refuse disposal.
Challenges. The report also described challenges that home hospice employees face when disposing controlled substances. Certain challenges were noted by both hospices as well as state hospice associations. First, some commenters described certain disposal methods, such as mail back programs or certain in home disposal methods, as being too costly. Commenters also reported that disposal can be time consuming and resource intensive.
Hospice officials also reported another challenge with disposal can be the lack of a witness. At times, some family members are unwilling to assist with drug counts or disposals. Other times the primary caregiver is not the family member present at the time of drug count or disposal. Though it was reported infrequently, hospices and hospice associations also reported that sometimes family members and caregivers refuse to dispose of controlled substances. Finally, the report noted that hospice officials indicated that inconsistencies between state and federal laws can cause challenges with in-home drug disposals.
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