The Medication Destruction form is the ideal method for documenting medication disposal. The form details are:
- Package in consecutively numbered groups of 50
- Includes removable label with unique ID number to be affixed to the Element MDS bottle
- Two-part design so a copy can be left with family or other party
- 8 inches wide x 4 5/8 inches tall
The Medication Destruction Form can be used in conjunction with the Element MDS kit to provide thorough documentation of the destruction process. These forms are ideal for Hospice organizations or other medical facilities that require accurate record keeping.
- When a patient passes (or medications are to be destroyed after discontinuation), the medications are documented on this two-part form
- The form includes a detailed listing of the medication, strength, count, pharmacy, and rx number.
- The nurse counts the medication along with a witness in the home. Both sign the form.
- The form includes a removable sticker with a unique ID code. The sticker is removed from the form and affixed to element MDS bottle.
- A copy of the form is left with the family.
- The medications are then destroyed according to element MDS directions.
- The sealed element MDS bottle and the top copy of the inventory form return to the Hospice offices.
- A compliance check is conducted by independent staff. Staff will verify the medications destroyed are consistent with those listed in the patient’s record. They will also make sure the label matches the documentation and that the tamper-evident seal is in place.
- They then dispose of the bottle in regular trash receptacles.
