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Ask the Expert: Comply with MM.4.80

Accreditation Connection, August 1, 2005

One way to comply with MM.4.80 is to simply box up medications.

Putting medications in a discontinued box is one method to signify to a technician or pharmacist that they need to be returned to the pharmacy, says Carolyn Ma, PharmD, a pharmacy consultant. Nurses will place any medications that a patient did not use into the bin, and a technician making daily rounds can pick up medications from the box and restock them.

Tip: Also keep a discontinued box in the refrigerator to hold IVs and other medications that require refrigeration, Ma says.

Automated dispensing machines made by companies such as Pyxis have a returns bin inside the cabinet, says Paul Mollo, PharmD, pharmacy director at Lourdes Hospital in Binghamton, NY. Lourdes uses Pyxis machines on the units.

Nurses place any medications that are discontinued or need to be returned to the pharmacy in the returns bin in the machine, Mollo says. The pharmacy then puts the medication back into stock if it has not expired.

Narcotics have their own special returns bin, and the pharmacy makes sure that the medications were removed at the appropriate time to prevent diversion, Mollo says. Pharmacists on the units conduct this audit daily.

Tip: Discard in front of a witness certain medications where diversion could be an issue, Ma says. This will help with certain state and federal requirements.

For example, if a patient only used 5 mg of a 10 mg syringe of morphine, have another nurse, pharmacist, or licensed professional serve as a witness, and document the process in a pharmacy log, Ma says.

Source: Hospital Pharmacy Regulation Report, published by HCPro, July 2005.

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