As advances are made in the delivery of health services in communities, so are changes to the role of the registered nurse (RN). More clients are receiving care in their homes, such as palliative services, and this has posed challenges to the clients, their families and to the RNs delivering care. Some of the challenges are the result of rural communities not having a local pharmacy to access controlled drugs or the local pharmacy not being open when the client requires the drug. For example, a client who experiences a pain crisis at 9:00 p.m. may not be able to access the pharmacy to fill a prescription for the medication needed.
The need for RNs to transport controlled drugs in rural communities has been recognized as a barrier to practice and has recently been addressed by Health Canada. In October 2013, an exemption to the Controlled Drugs and Substances Act (1996) was released. Section 56 “Class Exemption for RNs Delivering Primary Health Care at a Health Facility in a Remote and/or Isolated Community” provides RNs with the authority to possess, provide, administer, transport, send and deliver controlled substances when providing primary health care services to patients located in a remote and/or isolated community, subject to the terms and conditions of this exemption. Any client that needs this service must be a patient of a district health authority or agency that is delivering the service. If you are not clear if this exemption applies to your practice setting, please speak with your management team.
The exemption does allow for the transportation of the controlled drug, but there are conditions that must be in place for this practice to occur. The client must be under professional treatment of the nurse, the controlled substance must be required for treatment by the client, the nurse must have a signed and dated order/prescription for the controlled substance and the RN must follow the policies and procedures for handling the controlled substance.
This practice is not without risk. The risk of the ability to maintain accurate drug counts, proper disposal and to protect the safety of the nurse all exist. We therefore advise you consider these risks when you consider implementing this practice in your district health authority or agency and to consult with your risk management team when developing policies related to this practice. There should be policies in place that clearly outline what processes the RN most follow, when counting , disposing narcotics, and provider safety considerations.
How should controlled drugs be stored safely in the client’s home?
In the hospital or long term care setting, controlled drugs and substances are kept in locked cupboards and are subject to regular inventory measures (e.g. periodic counts by nursing staff). While this requirement is clearly stated in legislation and regulations for health care facilities, these same regulations do not apply once the controlled substances are in the client’s home. Because a high percentage of drug diversion occurs from family member’s prescriptions, it is important that clients receive education on the best ways to safely store their prescribed controlled drugs in the home.
Registered nurses need to advise their clients to only keep the minimum amount of their controlled drug in the home; preferably by requesting a smaller supply from their provider or pharmacist. Diversion and theft of controlled substances occur more frequently when these medications are left in plain sight or there is open discussion about their presence in the home. Once in the home, controlled drugs and substances should be kept in a secure location, preferably a locked box or cupboard; with the key kept in the custody of a responsible adult.
How can unused controlled drugs and substances in the home setting be disposed of safely?
Similar to regulations and policies for storage of controlled drugs and substances, health care facilities also have policies on disposal of these medications; however there are no such mechanisms regarding disposal of controlled drugs and substances in the home once the medications are no longer required. As with any other prescription, individuals should not take or share a prescribed controlled drug that is not their own. Registered nurses need to advise clients to return any controlled drugs that are no longer required directly to a pharmacy for proper disposal.
March 27th, 2014