Contents
1 Aim
The aim of this document is to set down the standards for disposal of medication that is no longer required including ward closures.
2 Link to overarching policy and, or procedure
This document links to the overarching safe and secure handling of medicines manual.
3 Disposal of non-controlled drugs
Any medicines, which are no longer required by the ward or department, are to be disposed of in the pharmaceutical waste bin, provided for the purpose.
3.1 Cytotoxic or cytostatic drugs
These must be disposed of in the purple lidded pharmaceutical waste bin. A list of these drugs can be found in the treatment rooms. This can be found on the medicines management intranet page. They are also identified by SystmOne on the medication chart.
4 Disposal of controlled drugs (CD)
4.1 Stock
- CDs must not be returned by wards or departments.
- Where they are no longer required, they must be removed by authorised pharmacy staff. Upon removal of the CD, the authorised member of the pharmacy staff will enter the appropriate stock balance and sign the CD register. The transaction must be witnessed by a designated practitioner who will also sign the register. The drugs must remain securely stored in the CD cupboard prior to their removal.
- Patients own, inpatients:
- where they have been held by the ward and are no longer required the same guidance as stock must be followed along with an entry in the clinical record
- Patients own community:
- for community services the destruction of controlled drugs and unknown substances by pharmacy services staff SOP must be followed, and the form completed
- in the first instance the patient or carer should be advised to take the medication to their supplying pharmacy
- staff with written permission, removal of patents own drugs form (staff access only) (opens in new window), take the medication to the supplying pharmacy, this should be fully documented, and consent sought
- medication can be brought back to the trust, pharmacy department for disposal. In this case permission must be gained and documented in the clinical record. This should only be done during working hours, please note that this should be the exception and, we do not have facilities for the destruction of controlled drugs
4.2 Care homes
Where community nurses are supporting the care of a patient in a care home, for example, maintaining a syringe driver and the patient dies, the following process must be followed:
- all medications are to remain at the care home for 7 days
- where staff have been administering the medication, for example, syringe driver set up, a final balance should be checked and recorded in the patients S1 record
- if the care home is a residential home, then the home makes arrangements for them to be collected by or taken to their pharmacy for destruction
If the care home is a nursing home, it is the responsibility of the home to destroy and dispose of them.
5 Disposal of patients own medication
5.1 Inpatients
Any medication brought into hospital by a patient is their property and as such cannot be destroyed without their permission. In the event that the patient. agrees to the destruction of the medication it is to be placed in the pharmaceutical waste bin. All medicines should be recorded in the ‘destruction of medication’ book which is held by wards.
If the patient or carer refuses to agree to the disposal of the medicines, this can either:
- be recorded in the patient’s clinical records and held in a sealed bag in a separate section of the medicine’s cupboard from all other stock until they can be returned to the patient on discharge
Or if the patient insists:
- be returned home. However, the patient and or their carer or relative must be advised that as the treatment regime will be reviewed whilst the patient is on the ward, it is likely that the supplied discharge medication will be different, and this poses a real risk that the wrong medication may be taken in future
Where patients lack capacity, this should be documented, and a best interest decision made.
If there are safety concerns in relation to the medication being returned home, then the nurse in charge is to consult with the consultant in charge of the patient’s care. The consultant then may make a decision to refuse to return the medicines and have them destroyed. For the safe disposal of any medicines staff should refer to the guidelines issued by their supplying pharmacy.
5.2 Community
Where excess medication is identified it is recommended that the patient or carer is advised to dispose of the medication at their local pharmacy.
In the rare case where the practitioner believes this will not occur and that this poses a significant risk then they should contact their manager for guidance and document any conversations in the clinical record. Staff should take into account capacity and risk, ultimately the medication belongs to the patient. Where this may indicate poor compliance, the prescriber or patients GP should be contacted, with a view to altering the repeat prescription.
6 Ward closures
6.1 Temporary or routine ward or department closures
Where a ward or department is closed for any reason for up to 7 days the responsible person will ensure that all medicines are appropriately stored in cupboards as agreed by the chief pharmacist.
The individual in charge at the time of such a closure will be responsible for ensuring the medication keys are stored in a secure place which has been agreed as suitable between the responsible person and the trust lead pharmacist.
Wherever possible, the doors to the ward or department will be kept locked during the period of closure.
6.2 Permanent closure of a ward or department for longer than 7 days
The management team will be responsible for notifying the trust chief pharmacist of the permanent closure.
The trust chief pharmacist will then be responsible for arranging the return and credit of disposal (as appropriate) of all medicines stocked on the ward or department. Relevant registers will be stored as per trust records management policy.
7 Removal of and disposal of unknown substances
Unknown substance may be illicit in nature and in accordance with its duties under the Misuse of Drugs Act. The trust does not knowingly permit the use of or dealing in illicit substances on its premises. In the event that staff become aware of someone on the premises having an unknown substance on them they should follow the guidance as detailed below:
- action if a visitor is in possession of an unknown substance:
- if any visitors are seen to be in possession of a suspected illicit substance, they will be asked to leave the premises
- if any visitor is seen or suspected to have passed illicit substances to a patient or other visitor, they will be asked to leave. The nurse in charge of the ward will then consult with the modern matron about the need to report the matter to the police, and bar any further visits by the person concerned (please refer to the trust’s drug misuse on trust premises policy)
- action if a patient is in possession of an unknown substance.
- in the event that it is a patient who is suspected to have illicit substances on them the nurse in charge of the ward will discuss their suspicions with them and ask that they voluntarily hand over the substance for destruction
- if the person refuses then a discussion with the manager must occur, and a decision on whether to involve security or the police made
This discussion must be held in the company of another staff member and this staff member must witness the actions of the nurse in charge once the substance has been handed over. Pharmacy should then be contacted who will destroy the substance in line with the destruction of controlled drugs and unknown substances by pharmacy services staff SOP.
Document control
- Version: 2.
- Unique reference number: 555.
- Approved by: Clinical policy review and approval group.
- Date approved: 4 July 2023.
- Name of originator or author: Senior pharmacist.
- Name of responsible individual: Executive medical director.
- Date issued: 17 July 2023.
- Review date: 31 July 2026.
- Target audience: Trust wide.
- Description of change: Minor amendments following review.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025