My father has medication for breathing treatments due to his pneumonia. It is a special prescription due to his heart condition (that I paid for as his POA and Health Care Representative). When they ran out of his prescription they substituted by using another patients breathing treatment medication that was not the same prescription. The nurse said it is common practice until the prescription is renewed. At which point they replace what they used from the other patient. Is this legal?
Not good practice at all!
CMS (Medicare & medicaid) guidelines allow for hospitals to change or substitute medications if the old drug is not in the hospitals existing pharmacy (formulary) and another deemed interchangeable is available. If your state also allows for NH / skilled nursing facilities to also do this, then the NH can substitute if the individual is having either Medicare or Medicaid paying for their stay in the facility.
I'd suggest that you contact the DON (director of nursing) for the facility to set up a care plan review asap. Most cannot allow for outside RXs or OTC meds to be dispensed. If the RX is coming from dads old MD, then it probably now needs to be reissued by the MD medical director of the NH with it ordered thorough their pharmacy vendor. If it's not covered by either M&M, then a substitute is done.
Getting a waiver for the special med might be able to be done. It's something to delicately work through at the care plan meeting. Good luck with this and be open to what they tell you the limitations are. If the rules are fixed and not acceptable to you, then you need to find a private pay facility that allows for a la carte care from multiple MD orders done.
Now they cannot give dad the medication that has another's name on it. But based on my experience with my mom & mil in NHs, the meds are in big blister packs in locked closet behind nurses station, so I'd never see where it got filled from....
Good to know!
Outside RXs & OTC meds are a problem for facilities for security, timeliness & payment. Theres no way to be sure of the "chain" of handling & so in theory not allowed. BUT facilities seem to allow it to happen if resident is new or there's a transitioning going on (like their on a 30 day course of RX but move from home / hospital to NH at day 19) or it's due to a lateral move (like fromNH #1 to NH #2). But once old RX is used up, it's going to be replaced a new RX that comes from the pharmacy this NH uses & on the payment ok list from Medicare or Medicaid. Unless Cricket can work out an agreement with the NH otherwise - & imo she needs to ask the DON for a care plan meeting asap to find out what options are.
If the resident is a "dual" so on Medicare & Medicaid, their meds have to come from the approved list & participating pharmacy in order to get paid by M&Ms. If the drug of choice is problematic, it can be switched to another but there's a trial needed & paperwork done to have drug qualified for M&Ms. Thyroid drugs have this often as Synthoid generic is cheap but Armour thyroid is expensive & needs refrigeration; M&Ms will want it defaulted to Synthoid rather than Armour unless it can be proved needed otherwise. NH have to insist on drugs cleared for the M&Ms cause they don't want to be in the position of resident running out of a needed medication cause a residents family didn't get meds or can't get to NH till weekend....... unless its totally private pay NH and things are all a la carte with cost not ever an issue.
I'd bet what happened is that Cricket1954's dad is somewhat new to NH & his RX "A" ran out, but "A" is not ever carried by the pharmacy group this NH uses &/or M&Ms pays for. So staff does a therapeutic interchange, from a vetted & pre-approved Medicare list - and somewhere in NH admissions paperwork dad or dpoa allowed for this. At NH there's standing orders from the MD who is the medical director of the NH to do interchanges & new RX automatically sent to their pharmacy group to fill. As an aside on this, both NHs my mom was in got daily RX delivery except for Sunday & federal holidays.
Yes, you're right huge problem would be if it's another's residents open RX. Like you can't used another persons open & used inhaler. Or give that bottle of Hydrocodone with your name on it to your neighbor. But if it's a multi day blister pack individual drug, it's going to be hard to prove it wasn't from the new RX for dad but pulled from someone else's pack. Despite what a "nurse" said.
When my mom went into a NH, I was surprised as to how drugs totally changed. Clueless as to how different meds in NH were to be. Those amber plastics that I made sure moms HEB pharmacy filled into the wide mouth ones with easy open arthritis rubbery tops were adios! Ditto for the hard pill RX that the pharmacist halved so she could swallow. Forget the licorice flavored gummie vitamins. Once in NH, otc stuff was given back to me & and once the RXs my mom moved in with were used up, all meds (RX & OTC) switched to big 90 multi day blister packs with RXs written by medical director & delivered by NH pharmacy partner & hung on a rolling multilevel medication cart with their name, RX # on a upper corner of a pack and cart in a locked but windowed "closet". Liquids on another cart & refrigerator in closet too. I'm sure there's a stash of as-needed emergency drugs there too. With "closet" adjacent to nurses station. Medication management staff ONLY could access closet to fill meds then placed on another rolling cart for AM meds in little disposable cups. & repeated thru day by set schedule. If the floor nurse RN was not medication management, she could not access closet either- the rules were very strict & adhered to. There would be no way for me to ever see which hanger meds were pulled from.
If staff found OTC like vitamins, nicorette gum, Tums, in residents rooms, they would be zippied with name on it & put into closet till the next care plan meeting.
Cricket probably could work out a compromise with the NH. Like the NH MD writes the RXs for the non-formulary meds but RX has to get filled by a pharmacy with secure delivery service & scheduled automatically. Probably will be a speciality pharmacy & billed at non-insurance rate. & Cricket has her Credit card on file for billing. So order, billing & delivery is seamless. It could be staggering expen$$$ive depending on the RX.
Definitely notify the DON, as his Medication issue (his running out of medicine) should have been addressed, when he was down to his last few doses, and then they could have notified You, or his Dr, and most of the time, the Pharmacy itself will issue an Emergency supply, until Authorization is recieved from the prescribing Dr., provided that it isn't a controlled Drug, ie: a Narcotic or something.
They should never run out in the first place, baring a Shortage in the local supply, which can happen, and then usually the Dr will change the Rx to something else or very simular.
I'm hoping that this was a one time thing, and not the unusual practice of this Nursing home, as Now that other patient is down one or more doses, And now your Dad has been given meds not Rx"d to him. I doubt very much that this is a Huge issue and hopefully your Dad was not harmed by this "one time dosing", however it isn't a very good practice in general! Because if they are doing it for your Dad, then Who Knows what they are doing for other Patients?
I'm surprised that they even told you, but that also makes me believe that they felt bad about the situation, and that they Are on the Up & Up, and that it Was only a one time thing. Even so, it should never happen again!