Please see the information below on how the Bureau of Narcotics and Dangerous Drugs address LTCs with Emergency Kits (E-kits).
MO 19 CSR 30-1.052:
(1) Long-term care facilities (LTCFs) and their suppliers shall maintain written records of transfers of controlled substances from the supplier to the LTCF emergency kit.
(2) The records shall include the date of transfer; the name of each controlled substance, the strength, dosage form and quantity; the name, address and controlled substance registration number of the supplier and the name, address and controlled substance registration number of the LTCF.
Note: LTCF cannot use federal DEA forms 222 to document transfer of controlled substance because DEA does not register LTCFs. BNDD transfer form should be used, including for Sched II substances. Transfer forms can be found on the BNDD website, www.health.mo.gov/BNDD, under Applications & Forms.
(3) No physician’s order or prescription shall be used for initial stocking or replacement of controlled substances in the emergency kit. Controlled substances contained in the kit shall be obtained from a pharmacy, hospital or practitioner who holds a controlled substances registration.
(4) The administration and medical staff of the LTCF, in conjunction with the primary supplier, shall designate in written protocols and procedures who may have access to the emergency kit, who may administer controlled substances from the emergency kit and under what circumstances and a list of the controlled substances it intends to maintain in the emergency kit. These protocols and procedures shall be subject to review and approval by the Department of Health. Only those individuals designated in the LTCF’s written policies and procedures shall have access to or administer controlled substances from the emergency kit.
It is the responsibility of the facility to establish proper protocols as to which staff members and under what circumstance they may access controlled substances contained in the E-Kit.
(5) Each administration of controlled substances from the emergency kit shall be based upon a practitioner’s order and shall be recorded in an administration record separate from the patient’s medical record. This administration record shall include: the date, patient’s name, drug name, drug strength, dosage, ordering practitioner’s name and name of the person administering the controlled substance.
Some things to note:
- BNDD will only issue a controlled substance registration to a LTCF that is licensed for skilled nursing. A facility that is assisted living only is not eligible for an Emergency Kit (E-kit) registration.
- Patient private medications (including controlled substance) do not fall under BNDD’s purview. We consider a resident living in an assisted living facility as being at their home. Their medications are considered their personal property. This would be the same as having a visitor come into your home and steal medication from the medicine cabinet. This is a theft that would be reported to the local law enforcement agency.
- The controlled substances in the emergency kit are considered to be LTCF “floor stock” and may be administered only upon the order of a practitioner. A record of transfer, such as an invoice or other record, must be made to document all transfers from the supplier to the LTCF. A prescription cannot be used as the record for initial stocking or replacement.
- Patient personal medications should not be stored with E-kit medications. Doing so impedes the ability to limit which staff can access facility owned controlled substances inside the E-Kit.