Unused Medications Research Articles

Recycling unused medications in hospitals is financially viable and good for the environment.

Considerable pharmaceutical waste is generated in hospital settings which can be reduced by recycling of unused medications. We sought to determine the recycling practices as well as quantify the volume and the value of oral solid medications returned from nursing units to the pharmacy departments at three urban hospitals. Unused oral solid medications were recycled at three sites and the net financial impact of this practice was calculated (cost recovered - labour costs). The results were extrapolated to all 21 hospitals within the health system. Recycling medications in 21 hospitals could divert ~461 000 units of medication from the incinerator, with an estimated net value of ~$415 000 per year. Recycling unused medications could save substantial amounts of money and reduce negative environmental impacts from disposal/incineration.

Piloting an opioid callback program in community pharmacies

BackgroundAlthough opioid prescribing has recently trended downward, opioid-related overdoses and deaths have drastically increased. Community pharmacists are accessible health care providers who are well positioned to disseminate information on opioid safety and to educate and counsel on medication use, managing adverse events, and proper medication disposal. Patient callbacks facilitate appropriate medication usage. We developed an opioid callback program that provides a framework for pharmacists to follow up with patients with an opioid prescription. ObjectivesThis study aimed to (1) describe the development of the opioid callback initiative and (2) report results from a pilot test in 2 community pharmacies. MethodsThe opioid callback process and data collection forms were collaboratively developed with community pharmacists at each site. Data recorded on the opioid callback forms were descriptively analyzed and chi-square test of independence explored differences by pain durations related to opioid disposal, security, and safety. Participating pharmacy staff were interviewed to identify facilitators and barriers to implementation, as well as opportunities for improvement. ResultsForty-one opioid callbacks were attempted and 36 were completed (87.8%). Pharmacists were statistically significantly more likely to discuss naloxone with patients with chronic pain (89.5%) than those with acute pain (46.2%). Pharmacists reported that the program successfully raised awareness of opioid disposal opportunities and safe opioid practices, including storage and naloxone ownership. They expressed patients’ willingness to answer questions and appreciation for the extra attention and care. ConclusionCommunity pharmacists are well positioned to address the opioid crisis as access points for medication questions, opioid safety education, opioid disposal, naloxone, and medications for people with an opioid use disorder. This study presents a proof of concept for a pharmacist-led opioid callback program. Expansion could help inform patients about how to use opioids safely, how to treat an opioid overdose, and where to dispose of unused medications.

Bioaccumulation and Depletion of the Antibiotic Sulfadiazine 14C in Lambari (Astyanax bimaculatus).

Antibiotics are present in the environment, primarily due to their release through wastewater treatment plants, agricultural practices, and improper disposal of unused medications. In the environment, these drugs can be bioaccumulated by organisms and transferred along the food chain. This is a problem when considering the consumption of fish meat. In the United States, legislation stipulates that the maximum residue limit for sulfadiazine (SDZ) should not exceed 100 μg kg-1. Lambari fishes have potential economic importance in aquaculture, as they are relatively easy to breed and can be raised in small-scale operations. Finally, studying the biology and ecology of lambari could provide valuable information about freshwater ecosystems and their inhabitants. The current work aimed to measure the bioaccumulation and depletion of the antibiotic SDZ 14C in lambari (Astyanax bimaculatus). For this purpose, the tests were divided into two stages; seven days of exposure and seven days of depletion, where one fish was randomly selected and sampled every day. In the exposure phase, the fish were fed the medicated feed three times a day at a concentration of 2.5 mg·g-1. The control fish were fed uncontaminated feed. For the depletion phase, the remaining lambari were transferred to clean tanks and fed uncontaminated feed three times a day. The fish samples were burned in the Oxidizer and the reading of radioactivity was performed in a liquid scintillation spectrometer. It is worth noting that on day 7 and day 14, the water in the aquariums was filtered through filter paper to collect the metabolic excrement. SDZ concentrations increased over the days and accumulation occurred in the fish, with day seven presenting the maximum accumulation value of 91.7 ng·g-1 due to feeding uptake. After the depletion phase on day 13, the value found was 0.83 ng·g-1. The bioconcentration factor calculated was 20 L·kg-1. After the bioaccumulation period, the concentrations of SDZ in the water and excreta were 4.5 µg·L-1 and 363.5 ng·g-1, respectively. In the depletion period, the concentrations in the water and excreta were 0.01 µg·L-1 and 5.96 ng·g-1, respectively. These results imply that there was little SDZ bioaccumulation in the fish, but that it was distributed in larger amounts in the water. This is due to the physicochemical properties of the molecule with the low Log P value. Regarding the maximum residue limit, the value was below the established value. This study contributes to understanding SDZ dynamics in an aquatic species native to Brazil.

A Household Survey on Extend of Home Medication Utilization and Storage Habits –A Cross Sectional Survey

Medicines plays a vital role in day-to-day life. Piling up of medicines in households leads to irrational use of medicines. This study aimed to investigate household medication taking behaviour, reasons of medicines storage in household, disposal practice of unused medication and determinacy of self- medication among family members. Study was carried out in Urban areas of North Karnataka by using interviewer administered questionnaire on 433 household participants. Data from the questionnaire were analyzed using appropriate statistical tools. Among surveyed households, 412 households have at least one unused medication in household which were stored unsafe and in reach of children. Out of 433 study participants (54.5%) were males and (45.5 %) were females. The stored drugs found in household mainly belongs to five categories; Antihypertensive (25.6%), Anti-diabetic (20.6%), analgesics and antipyretics (14.1%), NSAIDs (11.5%) , Anti –biotics (10.2%) . Majority of the drugs (84.7%) were purchased on prescription .96.9% of them are throwing the unused medication in garbage. We found that a significant proportion of the medications were found in the Urban households and had stored unused medication in household for future use and none of those medicines are stored safely and the unused medications were not properly disposed too. Hence there is need to conduct a programme to create necessary awareness among the public regarding storage and safe disposal methods of unused drugs.

Disposal of household medications and consumer perception of risk

The objective of this research is to investigate the relationship between the disposal of household medication waste and the perception of risks associated with the disposal of household medication waste in the Sertão region of Pernambuco, Brazil. Despite the respondents of the survey demonstrating a high level of agreement (around 90%) regarding the risks associated with improper medication disposal, such as accidental ingestion, soil and water pollution, and public health hazards, the Chi-Square test of independence did not identify a relationship between the variables of having already disposed of medication, disposal of liquid medications, and disposal of pills/capsules. In other words, having an awareness of the risks does not necessarily promote proper disposal of these unused medications. However, having awareness of the risks does increase the likelihood of participating in medication take-back programs at local pharmacies. Therefore, it is crucial to implement social awareness initiatives aimed at increasing citizens' perception of proper management of household medication waste.

Bringing Opiates Off the Streets and Undertaking Excess Scripts: A novel opiate reclamation and prescription reduction program

BackgroundOpioid diversion and misuse continue to present problems in modern medicine. The “opioid epidemic” has claimed more than 250,000 lives since 1999, with studies pointing to prescription opioids as the culprit for future opiate misuse. Currently, there are no well-described, data-driven processes to educate surgeons on reducing opiate prescribing, informed by personal practice patterns. We designed and implemented a novel opiate reclamation and prescription reduction program for surgeons to reclaim unused medications and decrease prescribing using individual provider data. MethodsWe performed a prospective collection of all unused opiate pain medications for general surgery postoperative patients from July 15, 2020 to January 15, 2021. Patients brought their unused opiates to their routine postoperative follow-up appointment, where they were counted and disposed of in a secure drug take-back bin. Reclaimed opiates were totaled, analyzed, and reported to the providers, who used their individual reclamation rates to refine prescribing habits. ResultsDuring the reclamation period, 168 operations were performed, with a total of 12,970 morphine milligram equivalents of opiate prescribed by 5 physicians. A total of 6,077.5 morphine milligram equivalents (46.9%) were reclaimed, which is the equivalent of 800 5-mg tablets of oxycodone. A review of these data led to a 30.9% decrease in opiate prescriptions by participating surgeons in addition to the reclamation of an additional 3,150 morphine milligram equivalents over the next 6 months. ConclusionContinuous monitoring of the medications returned by patients now continues to inform our providers’ prescribing practices, decreases the amount of opiates in the community, and improves patient safety.

Prescription Opioid Use for Acute Pain and Persistent Opioid Use After Gynecologic Surgery: A Systematic Review

(Abstracted from Obstet Gynecol 2023;141:681–696) Although opioid analgesics can be an effective pain control method in the acute postoperative period, their use comes with risks such as opioid misuse, persistent use, or opioid use disorders. As most postsurgical patients use less than half of their prescribed opioids (and rarely dispose of unused medication), millions of legitimately prescribed opioid tablets are available for diversion and misuse annually.

How sustainable are daily medicine consumption practices? The case of a fragile coastal area, Arcachon Bay (SW,France)

The potentially negative environmental effects of pesticides and antibiotics are a source of concern for public health. Many studies in recent years have focused on so-called “emerging micropollutants” emanating from domestic activity and found primarily in cleaning products, cosmetics, and medicines. This awareness of potential risks to the natural environment has evolved considerably since the 1970s. Sustained population growth in urban areas has forced public policy makers to pay more attention to the links between health and the environment, and specifically to the complexity of medicine consumption. Using a practice theory approach, this article aims to identify how sustainable daily medicine consumption practices are. Our research is based on the analysis of medicine consumption in relation to four interdependent elements: prescription, treatment, unused medication, and representations of environmental issues. First, the background of practice theory and sustainable medicine consumption are discussed. This approach is then applied to quantitative data from a questionnaire survey on consumers that we conducted in a French coastal area subject to specific demographic pressure and micropollution of the water. A multivariate statistical exploratory analysis of the data set highlights the structure of the practices concerned, and the extent to which environmental issues are considered when unused medication is disposed of. We conclude by highlighting the relevance of our approach in understanding the complex nature of sustainable medicine consumption, which involves diverse communities of practice. We also underline the need for public policy to target all stakeholders in the medicine consumption process, from medical professionals to end users.

Environmental Impact and Sustainable Solutions for Pharmaceutical Waste Management: An Empirical Investigation

The expansion of the pharmaceutical industry has raised concerns about the environmental repercussions stemming from pharmaceutical waste. Inadequate management of waste and disposal have caused hazardous chemicals to be released into the environment, putting the wildlife and people in danger. This summary delves into the environmental consequences of pharmaceutical waste and highlights sustainable solutions for efficient waste management. Pharmaceutical waste encompasses expired or unused medications, packaging materials, and by-products from manufacturing processes. It contains biologically active compounds that can persist in the environment for extended periods. These materials have been found in lakes, soil, and animals, and can cause an imbalance in the ecology and can damage different marine species. To make matters worse, incorrect disposal of pharmaceutical drugs can pollute drinking water, thus posing a serious risk to people's health. Addressing these pressing issues necessitates the implementation of sustainable solutions for pharmaceutical waste management. This abstract explores various approaches, including source reduction, proper disposal practices, and the adoption of advanced treatment technologies. Source reduction involves minimizing the generation of pharmaceutical waste by implementing measures such as improved inventory management and the development of eco-friendly manufacturing processes. Less waste generated can help the environment. The right way to discard medicines is to drop them off at designated areas or take advantage of return programs. These initiatives aim to prevent inappropriate disposal of pharmaceuticals in household waste or by flushing them down the toilet. By establishing dedicated channels for disposal, the risks of environmental contamination can be significantly reduced. Additionally, the exploration of advanced treatment technologies, such as incineration, chemical treatment, and biodegradation, is crucial for effective pharmaceutical waste management. These technologies aim to eliminate or neutralize hazardous compounds present in pharmaceutical waste, thereby minimizing the environmental impact.

Patients prefer free drug disposal options delivered by pharmacists at the point of care: Results of a decision tree analysis of a national factorial vignette panel survey.

Unused opioid medication in the home increases risk of medication diversion, misuse, and unintended harm. The United States Federal Food and Drug Administration is currently considering the implementation of a risk evaluation and mitigation strategy (REMS) program that would require US pharmacists to provide drug disposal products with opioid prescriptions. Still, little is known about consumer preference for drug disposal method. The objective of this study was to identify product and program characteristics associated with consumer preference for at-home drug disposal products. A 2x2x3x3 full-factorial design was employed to text-based vignettes representing opioid analgesic disposal scenarios. Each vignette varied on four characteristics: product cost (free vs paid), ease of use (a mail back envelope, bringing medication to a takeback site, and an at-home drug deactivation pouch), potential environmental impact (incineration), and point of access (pharmacy, community organization, and prescriber). Of the 36 possible vignettes, 12 were removed as they represented a non-realistic combination of vignette characteristics. The remaining 24 were administered to a panel of patients with controlled-substance use in the past six-months. Decision tree modeling and general linear mixed (GLM) models were used sequentially to identify product characteristics associated with patient drug preferences RESULTS: A total of 1,006 participants completed all vignette drug disposal scenarios. Regression tree analysis found that the most important predictor of use was cost followed by ease of access and product design. GLM showed that takeback programs offered at a pharmacy were the most preferred disposal option followed by at-home products (mailed envelope or deactivation system) dispensed with the prescription. Programs that provide disposal resources directly to the patient at no cost with their prescription are likely to optimize willingness to dispose. Findings support the FDA's plan for a REMS program requiring pharmacies to distribute mail-back envelopes to patients when dispensed opioids.

Excess Opioid Medication and Variation in Prescribing Patterns Following Common Breast Plastic Surgeries.

Purpose: Excess opioid prescribing has societal impacts including addiction, dependence, and misuse. This study aims to investigate prescribing patterns and self-reported patient experiences with opioid use, pain control, and disposal of unused medication following common breast surgeries. Methods: A total of 46 patients undergoing 5 breast procedures were identified during a predefined 14-week period. All procedures were carried out at a single tertiary care hospital by 9 plastic surgeons. Provincial narcotic monitoring program provided linked prescription information for identified patients. All patients were invited to participate in a telephone interview regarding postoperative opioid use. Results: A total of 41.6% of patients received and filled an opioid prescription following a breast procedure. Hydromorphone was the most commonly prescribed narcotic. The average number of opioid tablets dispensed following breast procedures was 31.9. Four percent of breast patients required an opioid refill. A total of 75% of breast patients used at least 1 over-the-counter analgesic, most commonly acetaminophen alone. Average self-reported pain score and total pain period were not significantly different between those using opioids and those not. A total of 6.7% and 23.1% of patients report returning excess narcotics to a pharmacy, while the majority report still having or self-disposing of excess tablets. Conclusions: Opioids are prescribed in excess for the breast procedures we analyzed. The majority of unused opioids were noted to still be at home or disposed of inappropriately. This suggests a role for reviewing opioid-prescribing patterns for common plastic surgery procedures to reduce the burden of the ongoing opioid epidemic.

Redispensing of expensive oral anticancer medicines: A practical application.

Increasing use of expensive oral anticancer medicines comes with the downside of a financial and environmental burden, partially caused by unused medication. Returned oral anticancer medicine to the pharmacy could be considered for redispensing providing guaranteed quality. This study aimed to identify and implement quality aspects and criteria for redispensing oral anticancer medicine in daily pharmacy practice. A systematic analysis was conducted to determine the eligibility of oral anticancer medicine for redispensing. Over a one-year period, the number of returned oral anticancer medicine accepted for redispensing was quantified, and the reduction in financial waste and environmental burden calculated based on this assessment. Four categories of quality aspects were identified for determining the eligibility of oral anticancer medicine for redispensing: Product presentation suitability (stability characteristics, storage requirements), physical condition (unopened or opened secondary or primary packaging, visual appearance), authentication (Falsified Medicines Directive, confirmation of initial dispense, recall), and additional aspects (remaining shelf life, period of storage in uncontrolled conditions). A standardized procedure for redispensing was implemented in daily pharmacy practice. During the study period, 10,415 oral anticancer medicine dose units out of 13,210 returns (79%) were accepted for redispensing. The total value of oral anticancer medicine accepted for redispensing was €483,301, accounting for 0.9% of the total value dispensed during this period. Furthermore, the potential reduction in environmental burden was estimated at 1132.1 g of potent active pharmaceutical ingredient. By implementing strict procedures considering all relevant quality aspects, redispensing of oral anticancer medicine can be successfully implemented into daily pharmacy practice, resulting in a significant reduction in financial waste and environmental burden.

Assessment of disposal practices for unused medication: a multi-center cross-sectional study of patients visiting public health facilities in northwest Ethiopia

Assessment of disposal practices for unused medication: a multi-center cross-sectional study of patients visiting public health facilities in northwest Ethiopia

Disposal Practices of Expired and Unused Medications Among Households in Punjab, Pakistan.

The practice of disposing expired or unused medications by different households is generally not considered and is largely neglected. The study was carried out to determine the disposal practices regarding expired and unused medications in rural areas of Punjab, Pakistan. The study was conducted by interviewing different households and students (rural areas) from different universities in Punjab, Pakistan. The sample size was 676 and the questionnaire was used for data collection. Out of 676 members, 552 (81.6%) had medications at the time of the visit. Only 14.5% (n= 80) were taking medication. Only 14.5% (n = 80) kept medication because the treatment was still in progress with the patients while 85.5% (n= 472) had medications that should be discarded. The main reasons for keeping the unused medications at home were completed treatment 34.7% (n= 164) after recovering from ailment. About 60.57% of female disposed the drugs in domestic trash while majority of male participants (48.72%) buried the drugs in the ground. Over 80% of respondents (n = 542) were unaware of the disposal methods. Almost half of the participants (n= 322) had no information about the impact of improper disposal. Statistically significant variations (p<0.001) were observed in the disposal practices depending on gender, age, education and occupation. Improper disposal of medication is a common practice in rural areas of Punjab, Pakistan. The launch of public education programs and the development of drug disposal facilities are very necessary to protect the environment and community health.

Medical Household Waste as a Potential Environmental Hazard: An Ecological and Epidemiological Approach.

Nowadays, the contamination caused by emerging pollutants is a global concern due to the lack of scientific evidence to demonstrate the risk or toxicity to humans due to the presence of pharmaceutical residues in the environment. This study aimed to identify and describe the disposal practices of unused and unwanted medications, as well as to analyze and identify the most frequent drugs determined on water bodies adjacent to the biggest urban population in Mexico. A two-phase study with an epidemiological and an ecological assessment was performed. The epidemiological phase was carried out with a descriptive cross-sectional study among citizens from Mexico City and the metropolitan area using an electronic survey applied to 719 subjects aimed to assess practices in which pharmaceutical products are disposed. The ecological phase included a review of scientific reports. The results show that nearly 83.5% of those surveyed use inappropriate practices for disposal medicines, the main ones are through the municipal dump or directly in the drain. The ecological approach was carried out by a systematic literature review of original reports published between 2013 to 2023; information about the class of drugs, active substance, environmental compartments, location, and concentration was extracted and presented. Fifty-one different types of pharmaceutical residues were detected in wastewater in Mexico City in the last decade. The results of this study can contribute to the application of public policies for waste management authorities to mitigate the socio-environmental risks due to the inappropriate disposal of medicines.

806 Excess Postoperative Opioid Prescribing in Pediatric Neurosurgery

INTRODUCTION: Introduction: The opioid crisis is worsening in the United States with opioid overdose deaths reaching record highs in 2020. Opioid medications prescribed at hospital discharge provide an unwitting source of excess opioids posing unique risks to pediatric patients, with half of pediatric overdoses in patients &lt;2 years of age. Although legislative efforts have significantly limited opioid prescribing, recent studies suggest these medications may still be overprescribed. METHODS: Methods: Pediatric patients undergoing neurosurgical procedures at Riley Hospital for Children were identified prospectively. Surgery type, length of stay, and inpatient use of opioid and nonsteroidal (NSAID) medications were collected. Patients were contacted 7 days after hospital discharge and asked to report the number of post-discharge prescribed opioid and NSAID doses used. RESULTS: Results: 119 patients participated. An average of 22.3 doses of opioid medication were prescribed at discharge, with a mean 3.9 doses used at 7 days. Seventeen patients (14.3%) were prescribed concomitant NSAIDs, and 40 patients (33.6%) used zero doses of prescribed opioid medication. Patients aged ≤13 years used less prescribed opioid doses (x̄ = 15.1%) than patients aged 13-17 (x̄=23.8%). Trends toward increased opioid use in patients undergoing spinal procedures were observed. Patients prescribed NSAIDs used 19.4% of opioid doses compared to 17.2% in those not prescribed NSAIDs. CONCLUSIONS: Conclusion: Pediatric neurosurgery patients used only 17.5% of prescribed opioids in 7 days after hospital discharge, creating excess unused opioid medication that may increase the risk of accidental ingestion and misuse. Opioid prescription amounts were subsequently limited, and follow-up data collection continues. The present study highlights the need for educational initiatives for providers to minimize excess opioids prescribed and for parents to safely dispose of leftover opioid medication.

Implementation of an opioid reduction toolkit in pancreatectomy patients significantly increases patient awareness of safe practice and decreases amount prescribed and consumed

BackgroundPostoperative opioid abuse following surgery is a major concern. This study sought to create an opioid reduction toolkit to reduce the number of narcotics prescribed and consumed while increasing awareness of safe disposal in pancreatectomy patients. MethodsPrescription, consumption, and refill request data for postoperative opioids were collected from patients receiving an open pancreatectomy before and after the implementation of an opioid reduction toolkit. Outcomes included safe disposal practice awareness for unused medication. Results159 patients were included in the study: 24 in the pre-intervention and 135 in the post-intervention group. No significant demographic or clinical differences existed between groups. Median morphine milliequivalents (MMEs) prescribed were significantly reduced from 225 (225–310) to 75 (75–113) in the post-intervention group (p < 0.0001). Median MMEs consumed were significantly reduced from 109 (111–207) to 15 (0–75), p < 0.0001), as well. Refill request rates remained equivalent during the study (Pre: 17% v Post: 13%, p = 0.9) while patient awareness of safe disposal increased (Pre: 25% v Post: 62%, p < 0.0001). DiscussionAn opioid reduction toolkit significantly reduced the number of postoperative opioids prescribed and consumed after open pancreatectomy, while refill request rates remained the same and patients’ awareness of safe disposal increased.

KNOWLEDGE AND AWARENESS OF THE MEDICINE DISPOSAL AMONG HEALTHCARE PROFESSIONALS

Pharmaceutical active preparations are designed with specific biological and physiological properties. These formulations possess desired therapeutic action against numerous diseases and infections. But some preparations have hazardous effects on the environment when it comes to disposal of medicines, it is necessary to know about the importance of proper waste disposal. The primary objective of the study is to know about the importance of the medicinal waste disposal system and the awareness among health care professionals especially past expiry date. The cross-sectional survey-based study was performed in Karachi. Data was collected through an online Google questionnaire form. The results were analyzed. Among 203 responders, 65% (n=132) were females while the other 35% (n=71) were males. Approximately 57.1% (n=116) agreed that they are aware of the hazards and disposal of medication waste and 63.05% (n=128) think that it is the responsibility of Pharmacies Association and other regulatory bodies for awareness of proper disposal of medicines. The study recommends that we establish uniform guidelines for the safe disposal of expired or unused medications. Significant problems and malpractices were identified for unused, and unwanted prescription medication, lack of a drug take-back system, proper disposal of medications &amp; surgical, inadequate awareness about disposal system adversely affecting our environment and health.

Magnitude of Medicine Wastage and Perceived Contributing Factors Among Public Health Facilities in Dire-Dawa City Administration, in Mid COVID-19 Pandemic in Ethiopia: Retrospective, Cross-Sectional Study.

World Health Organization refers medication waste as expired, unused, spilled, and contaminated pharmaceutical items, medications, vaccines, and sera. Budget constraints in financing the health care system together with huge amount of wastage and disposal costs of unused medications at LMIC create a serious risk to the economy, health care system and environment. Thus, the aim of this study was to assess the rate of medication waste and to identify contributing factors in public health facilities in Dire-Dawa city. An institution-based retrospective, cross-sectional study was supplemented by a qualitative study design from May 10 to June 10, 2021, at 2 public hospitals and 14 health centers. Qualitative data were collected by self-administered questionnaires and 2 years record review. In-depth interviews were used to obtain qualitative data. Excel sheets and SPSS version 20 and thematic analysis were used to analyze quantitative and qualitative data. An average medicine wastage rate was 3.07% between 2010 and 2012 EFY, in Dire-Dawa public health facilities that worth 4,048,594.0 ETB. The most wasted class of medication was anti-infectives, accounting for 2,360,330 ETB (58.3%), while tablets 2,615,391 ETB (64.6%). Medical waste has been linked to several issues, including pushing nearly expired medications to healthcare institutions, lack of clinician involvement in medication selection and quantification, rapid changes in treatment regimens, and the existence of overstocked medication shelves. The average rate of medication waste was higher than the allowed level of 2%. The only medications that should be accepted by medical facilities are those that can be used before they expire. All prescribers should receive lists of the drugs that are readily available from the pharmacy department, and clinicians should be involved in the quantification and drug selection processes to increase the effectiveness of the use of medications.

Nurse delivered medication safety screening program for home care visits.

Home care clients have safety barriers related to medication storage, disposal, and safe use of opioids. Limited research is available regarding medication safety initiatives in the home care setting. This study evaluates a medication safety initiative, linked with opioid misuse and overdose prevention screening, for home care clients with different levels of service. Training and screening tools designed for community pharmacies by the Opioid & Naloxone Education (ONE) Program were modified for use by home health nurses. All new admits to the home health services were screened for medication storage, medication disposal, and use of pain medications. Patients taking opioids were screened for opioid-specific risks. Interventions based on screening results included education, provision of medication lock boxes, drug disposal packets, and/or naloxone. Most home care clients (85%) are properly storing their medication and 38% were not properly disposing unused medications. Higher levels of care had greater pain medication needs, including the provision of naloxone. This study demonstrates the opportunity to incorporate medication safety screening into nursing home health visits.