Purpose Statement

A Custody Exchange allows providers to transfer possession of a controlled substance Med Kit from one individual to another within the First Due Medications module.

This workflow helps agencies maintain accurate custody records by verifying the Med Kit's security, documenting the transferring and receiving providers, and capturing the agency-configured signature requirements.

Providers can also use Retain Custody to document that they will continue possessing the Med Kit without transferring custody to another individual.

Background Information

Custody Exchange is available for controlled substance Med Kits and allows agencies to document the transfer of medication possession between personnel.

The workflow may include:

• Verification of the physical Med Kit seal number.
• Physical medication inventory verification when Break and Count is required or selected.
• Occurrence reporting for seal or medication discrepancies.
• Authentication and signatures from the transferring and receiving providers.
• Additional signature roles based on agency configuration.
• Documentation when a provider retains custody instead of transferring possession.

Exclusive Possession

Access to Custody Exchange functionality depends on the agency's Exclusive Possession setting, located under:

Medications → Setup → General Settings → Med Kits → Exclusive Possession of Controlled Substance Kits

When Exclusive Possession is enabled:

• The provider currently recorded as possessing a controlled substance Med Kit can initiate standard medication actions for that kit.
• Eligible users can initiate a standard Custody Exchange from the Medications Dashboard for controlled substance Med Kits they currently possess.
• Start Exchange is also available for eligible controlled substance Med Kits that have no provider currently recorded in possession.
• Users can initiate an exchange directly from an applicable Med Kit when the custody assignment and their permissions allow it.
• Users who do not possess a Med Kit assigned to another provider cannot initiate its standard medication actions unless they have the applicable override permissions.

When Exclusive Possession is disabled, users who do not currently possess the Med Kit may initiate a standard Custody Exchange when they have Meds - Global Custody Exchange permission.

When this occurs, eligible users can select Start Exchange from the Medications Dashboard to initiate the custody process, even when Exclusive Possession is enabled.

Agency-Configured Signature Requirements

Custody Exchange signature requirements are configured by administrators under:

Medications → Setup → Signature → Custody Exchange

Depending on agency configuration, the signature process may include:

• Customized signature role titles.
• Up to four configured signature roles.
• Required and optional signatures.
• Signature Only or Signature and PIN validation.
• Saved profile signatures, when enabled.
• Rank or Qualifier restrictions that determine which personnel can complete specific signatures.

The default signature roles include Transferring Provider and Receiving Provider. However, agencies may customize these titles and configure additional signature requirements.

The user initiating the standard Custody Exchange is documented as the Transferring Provider. The appropriate provider should initiate the exchange to ensure accurate custody documentation.

Required Permissions

Users completing a Custody Exchange must have the appropriate access and permissions.

• Med Kits: Access to the applicable controlled substance Med Kit.
• Meds - Custody Exchange: Provides applicable Custody Exchange functionality.
• Meds - Global Custody Exchange: Allows applicable users to initiate a standard Custody Exchange without currently possessing the Med Kit when Exclusive Possession is disabled.
• Override Exclusive Possession: Allows authorized users to access custody controls when another provider possesses the Med Kit and Exclusive Possession is enabled.
• Possession Override: Allows authorized users to override the existing custody assignment.
• Medications Dashboard Access: Required when initiating an exchange from the Dashboard.

Important Notes:

• Override Exclusive Possession and Possession Override are associated with the separate Custody Exchange Override workflow.
• Meds - Global Custody Exchange does not override the Exclusive Possession setting.
• When Exclusive Possession is enabled, eligible users may initiate a standard Custody Exchange for a Med Kit with no recorded custodian.
• Personnel completing signatures must meet any Rank or Qualifier restrictions configured by the agency.

Video

Step-by-Step Guide

1. Determine Where to Initiate the Custody Exchange

A standard Custody Exchange can be initiated from the Medications Dashboard or directly from the applicable controlled substance Med Kit.

Before beginning:

• Verify that the Med Kit is configured for controlled substances.
• Review the current custody assignment.
• Confirm that you are the appropriate provider to initiate the custody transfer.
• Determine whether to begin from the Medications Dashboard or Med Kits.
• Ensure the receiving provider is available to complete the custody transfer.

From a Med Kit

2. Initiate a Custody Exchange from the Medications Dashboard

• Navigate to the Medications Dashboard.
• Locate the controlled substance Med Kit requiring a custody transfer.
• Review the available medication actions and current custody assignment.
• Select Start Exchange for the applicable Med Kit.
• Continue to the Custody Exchange options.

Important Notes:

When Exclusive Possession is enabled, Start Exchange is available for eligible controlled substance Med Kits that:

• Are currently assigned to the logged-in user.
• Do not have a provider currently recorded in possession.

Med Kits currently possessed by another provider do not offer the same standard medication actions to the logged-in user. Dashboard availability also depends on agency configuration and user permissions.

3. Initiate a Custody Exchange from Med Kits

• Navigate to the Medications module.
• Select Med Kits.
• Locate and open the applicable controlled substance Med Kit.
• Review the current custody assignment.
• Select either the Custody Exchange control or the Refresh icon when available.
• Continue to the Custody Exchange options.

Important Notes:

• When Exclusive Possession is enabled, users can initiate standard medication actions for Med Kits they currently possess.
• Users who do not possess a Med Kit assigned to another provider will not have access to its standard medication actions unless they have applicable override permissions.
• A Med Kit without a recorded custodian may be eligible for a standard Custody Exchange.

4. Select the Custody Exchange Workflow

After initiating the workflow, select the action that reflects what is occurring.

• Custody Exchange: Transfer possession of the controlled substance Med Kit to another provider.
• Retain Custody: Document that the current provider will continue possessing the Med Kit.
• Cancel: Exit without completing a custody action.

Select Custody Exchange when another provider will assume possession.

If the current provider will continue possessing the Med Kit, follow the Retain Custody workflow below.

Non-Possessing Provider:

Possessing Provider:

5. Retain Custody (If Applicable)

Retain Custody allows the current provider to document continued possession without transferring the Med Kit to another individual.

• From the custody options, select Retain Custody.
• Select the appropriate retention reason:
  • Operational
  • Shift / Staffing
  • Administrative
  • Emergency / Contingency
  • Other
• Enter additional information in the Comments field when appropriate.
• If Other is selected, provide the required explanation.
• Select Retain Custody to continue.
• Complete the required authentication.
  • Enter your four-digit PIN when configured and required.
  • If a PIN is required but not configured, enter your First Due account password.
• Select Continue when prompted.
• Review the displayed provider information.
• Complete the signature using Fill, when a saved profile signature is available and permitted, or manually sign using the available input method.
• Select Save to complete the Retain Custody workflow.

The current provider remains recorded as possessing the Med Kit.

6. Enter and Verify the Current Seal Number

When completing a Custody Exchange for a seal-secured controlled substance Med Kit, the physical seal must be verified.

• Locate the seal number physically attached to the Med Kit.
• Enter the seal number into the applicable field.
• Select the Plus (+) icon to add the entered seal number.
• If multiple seals are required, enter each applicable seal number.
• Review the entered seal information.
• If a seal number was entered incorrectly, select the Tag icon to edit the entry.
• Select Save to initiate the verification process.

First Due compares the entered seal number with the seal information currently recorded for the Med Kit.

7. Report a Seal Occurrence (If Applicable)

If a seal is broken, damaged, or requires additional documentation, use the available occurrence-reporting workflow.

• From the seal verification screen, select Report.
• Review the default report recipient.
• Modify the recipient when necessary.
• Enter a description of the occurrence.
• Complete the report using the available submission controls.

The occurrence-reporting workflow may automatically populate recipients based on agency configuration. Verify the intended recipients before submitting the report.

8. Continue When the Seal Matches

If the physical seal number matches the seal recorded in First Due, users can continue without breaking the seal or choose to complete a physical medication Count.

• Review the successful seal verification.
• Select one of the available options:
  • Sign: Continue directly to the Custody Exchange signature workflow.
  • Break and Count: Break the seal and physically verify the medication inventory before transferring custody.
• Follow agency policy when determining whether a physical Count is necessary.

A matching seal allows users to proceed directly to signatures, but agencies may require additional physical verification under their internal procedures.

9. Complete Break and Count When Required

If the entered seal number does not match the seal recorded in First Due, the system requires Break and Count.

• Review the seal mismatch notification.
• Select Break and Count.
• Physically break the seal according to agency procedures.
• Review the medication inventory displayed for each applicable pouch.
• Verify the medication inventory physically present against the information recorded in First Due.
• Review applicable medication details, including:
  • Medication Form
  • Quantity
  • Expiration Date
  • Lot Number
  • Serial Number, when applicable
• Use the available verification controls to document whether the physical inventory matches the system inventory.
• Document any discrepancies using the applicable workflow.
• Complete the Count and continue through any required resealing steps.
• Select Sign and Finish when ready to proceed to the Custody Exchange signature process.

Important Notes:

• Medication inventory is verified at the applicable pouch level.
• When the same Medication Form has inventory in multiple pouches, each pouch must be verified separately.
• Medication Forms with a current recorded quantity of 0 do not appear during the physical Count.
• Par and Min indicators provide inventory-status information but do not replace physical medication verification.

10. Document Medication Discrepancies (If Applicable)

If the physical medication inventory does not match the information recorded in First Due, document the discrepancy using the available verification controls.

• Locate the medication with the discrepancy.
• Select the X indicator to identify that the physical inventory does not match the expected inventory.
• Review any applicable occurrence information.
• Complete additional occurrence documentation when necessary.
• Continue according to agency procedures.

A controlled substance discrepancy will generate an Occurrence Report. The Occurrence Report identifies that a discrepancy exists but does not determine its cause or assign responsibility.

11. Avoid Saving the Custody Exchange as a Draft

During the Count portion of a Custody Exchange, Save as Draft may be available.

Whenever possible, complete the Custody Exchange and all required signatures in the same session.

Important Considerations:

• Save as Draft: Saves the unfinished Count, but does not preserve the original Custody Exchange workflow.
• Close: Exits the workflow without saving, causing users to lose their Custody Exchange and Count progress.

12. Save as Draft Only When the Workflow Must Be Interrupted

If an operational need requires the workflow to be interrupted:

• Select Save as Draft.
• Reseal the Med Kit when applicable, or select Skip Seal.
• If Skip Seal is selected, enter the required reason.
• Save the draft.

The unfinished Count can later be accessed using Resume Count, but it resumes as a standard Count rather than the original Custody Exchange.

13. Select Sign and Finish

For an uninterrupted Custody Exchange:

• Select Sign and Finish after all required available inventory has been verified.

• Both providers may be required to sign to complete the custody transfer.

Complete and Sign Later is not available during an active Custody Exchange.

14. Enter a New Seal Number (If Applicable)

If Break and Count requires the Med Kit to be resealed, complete the applicable seal entry process.

• Apply the new physical seal according to agency procedures.
• Enter the new seal number into the applicable field.
• Select the Plus (+) icon to add the seal number.
• Repeat if additional seals are required.
• Verify that the entered seal information matches the physical Med Kit.
• Select Sign to continue to the Custody Exchange signature workflow.

15. Review the Custody Exchange Signature Requirements

After selecting Sign or completing Break and Count followed by Sign and Finish, First Due displays the agency-configured Custody Exchange signature workflow.

• Review the signature roles displayed at the top of the signature screen.
• Identify the signature role associated with the Transferring Provider.
• Review the additional signature roles required by your agency.
• Confirm that the appropriate personnel are available to complete the required signatures.

Important Notes:

• Signature role titles may differ between agencies.
• Agencies can configure up to four signature roles for the event.
• Signature roles may be required or optional.
• All required signatures must be completed before the Custody Exchange can be finalized.
• Rank and Qualifier restrictions may limit which personnel are available for individual signature roles.

16. Authenticate the Transferring Provider

The user initiating the standard Custody Exchange is documented as the Transferring Provider.

• Select the appropriate transferring signature role at the top of the signature screen.
• Complete the agency-configured authentication method.
• Depending on configuration, this may require:
  • A four-digit PIN.
  • The user's First Due account password if a PIN is required but has not been configured.
• Select Continue to validate the entered credentials, when prompted.
• Review the displayed provider information, which may include name and certification.
• Complete the signature:
  • Select Fill if a saved profile signature is available and permitted by agency configuration.
  • Otherwise, manually enter the signature using the available device input method.
• Continue to the next required signature role.

17. Select and Authenticate the Receiving Provider

The Receiving Provider is the individual who will assume custody of the controlled substance Med Kit.

• Select the appropriate receiving signature role at the top of the signature screen.
• Select the provider who will receive custody.
• If necessary, use the available search field to locate the provider.
• Verify that the correct individual has been selected.
• Complete the agency-configured authentication.
  • Enter the provider's four-digit PIN when configured and required.
  • If a PIN is required but not configured, enter the provider's First Due account password.
• Select Continue to validate the credentials, when prompted.
• Review the displayed Receiving Provider information.
• Complete the signature:
  • Select Fill if a saved profile signature is available and permitted.
  • Otherwise, manually enter the signature.

Important Notes:

• Available personnel may be restricted based on agency-configured Rank or Qualifier requirements.
• The selected Receiving Provider becomes the recorded custodian when the Custody Exchange is successfully completed.

18. Complete Additional Required Signatures (If Applicable)

Depending on agency configuration, additional signature roles may be required during the Custody Exchange.

• Review the signature roles displayed at the top of the signature screen.
• Identify any remaining required signatures.
• Select the next required signature role.
• Select an eligible provider from the available personnel list.
• Complete the applicable authentication requirements.
• Capture the required signature.
• Repeat until all required signatures have been completed.

Important Notes:

• Signature role titles and the number of required signatures vary based on agency configuration.
• Personnel must meet any configured Rank or Qualifier restrictions.
• Optional signatures do not prevent the event from being completed.
• Attempting to save before completing all required signatures may result in a validation error.

19. Save and Complete the Custody Exchange

Once all required signatures have been completed, finalize the custody transfer.

• Review the completed signature information.
• Verify that all required signature roles have been satisfied.
• Confirm that the correct Receiving Provider has been selected.
• Select Save to complete the Custody Exchange.
• Allow First Due to process the custody transfer.
• Return to the applicable Med Kit and review the custody information.
• Verify that the Receiving Provider is now recorded as possessing the Med Kit.
• If applicable, confirm that the recorded seal information matches the physical Med Kit.

Best Practices

• Confirm the correct Transferring Provider. The user initiating the standard Custody Exchange is documented as the Transferring Provider.
• Review the current custody assignment. Under Exclusive Possession, eligible users can initiate standard exchanges for Med Kits they possess or Med Kits with no recorded custodian.
• Maintain clear custody accountability. Controlled substance Med Kits should generally have a recorded custodian, although operational circumstances may result in temporarily unassigned kits.
• Understand Exclusive Possession. Users cannot initiate standard medication actions for Med Kits currently possessed by another provider without the applicable permissions.
• Use the appropriate starting location. Initiate standard Custody Exchanges from the Medications Dashboard or Med Kits, depending on available controls and permissions.
• Keep both providers available. Ensure the transferring and receiving providers can complete the required signatures before beginning the workflow.
• Use Retain Custody when appropriate. If the current provider will continue possessing the Med Kit, document retention rather than completing an unnecessary transfer.
• Verify seal information carefully. Compare the physical seal number with the number entered into First Due.
• Complete Break and Count when required. A mismatched seal requires physical medication inventory verification before custody can be transferred.
• Document discrepancies appropriately. Use occurrence-reporting options and follow agency procedures when medication inventory or seal discrepancies are identified.
• Avoid Save as Draft. A resumed Custody Exchange Count becomes a standard Count and does not complete the original custody transfer.
• Review agency-specific signature requirements. Customized User Roles and required signatures may vary between agencies.
• Verify signature eligibility. Rank and Qualifier restrictions may limit which personnel can complete a particular signature.
• Complete all required signatures. Confirm every required signature role has been satisfied before saving.
• Verify the Receiving Provider. Confirm the correct individual before finalizing the custody transfer.
• Confirm the final custody assignment. After saving, verify that the intended Receiving Provider is displayed as possessing the Med Kit.

Troubleshooting & FAQs

Why don't I see Custody Exchange on a controlled substance Med Kit?

Access depends on the current custody assignment, the Exclusive Possession setting, and your permissions. When Exclusive Possession is enabled, users who do not currently possess a Med Kit assigned to another provider cannot initiate standard medication actions unless they have the applicable override permissions.

Can I start a Custody Exchange from the Medications Dashboard when Exclusive Possession is enabled?

Yes. Start Exchange is available for eligible controlled substance Med Kits that the logged-in user currently possesses or that have no provider currently recorded in possession.

Why can I see a Med Kit on the Dashboard but cannot select Start Exchange?

Seeing a Med Kit on the Dashboard does not automatically provide access to its medication actions. When Exclusive Possession is enabled, Start Exchange is available for eligible controlled substance Med Kits currently assigned to the logged-in user or Med Kits with no recorded custodian.

If another provider possesses the Med Kit, the logged-in user cannot initiate its standard Custody Exchange.

Can I start a Custody Exchange when no provider currently possesses the Med Kit?

Yes. When a controlled substance Med Kit has no provider currently recorded in possession, eligible users can select Start Exchange from the Medications Dashboard, even when Exclusive Possession is enabled.

Agencies should generally maintain an assigned custodian for controlled substance Med Kits, but this functionality accommodates operational situations where a kit temporarily has no recorded custodian.

Can I perform a Custody Exchange Override from the Dashboard?

No. Custody Exchange Overrides must be initiated directly from the applicable controlled substance Med Kit.

Who can initiate a Custody Exchange when Exclusive Possession is enabled?

The provider currently recorded as possessing the Med Kit can initiate its standard Custody Exchange.

Eligible users can also initiate a standard Custody Exchange for a controlled substance Med Kit with no recorded custodian.

When another provider currently possesses the Med Kit, authorized supervisors with applicable override permissions can use the separate Custody Exchange Override workflow when necessary.

Who can initiate a Custody Exchange when Exclusive Possession is disabled?

The current custodian can initiate the applicable exchange. Users who do not currently possess the Med Kit need Meds - Global Custody Exchange permission.

Does Meds - Global Custody Exchange override Exclusive Possession?

No. Meds - Global Custody Exchange applies to standard Custody Exchange access when Exclusive Possession is disabled.

Who is documented as the Transferring Provider?

The user initiating the standard Custody Exchange is documented as the Transferring Provider. This also makes it important to verify the custody status when initiating an exchange for a Med Kit with no recorded custodian.

When should I use Retain Custody?

Use Retain Custody when the current provider will continue possessing the controlled substance Med Kit instead of transferring it to another provider.

Is a comment required when retaining custody?

Comments can be entered to document the circumstances. When Other is selected as the retention reason, a comment is required.

What happens if the seal number matches?

Users can select Sign to continue directly to the signature process or choose Break and Count to physically verify the medication inventory.

What happens if the seal number does not match?

First Due requires Break and Count before the custody transfer can continue.

Can I correct a seal number entered incorrectly?

Yes. Use the Tag icon during seal entry to edit the number before completing verification.

Can I report a seal issue during the exchange?

Yes. Select Report during seal verification to document an occurrence and select the appropriate recipients.

Do I need to count medications during every Custody Exchange?

Not necessarily. When the physical seal matches the number recorded in First Due, users may proceed directly to signatures unless agency policy requires a physical Count.

Why doesn't a Medication Form with quantity 0 appear during Break and Count?

Medication Forms with a current recorded quantity of 0 are excluded because First Due does not expect physical inventory to be present.

Why do I see the same Medication Form in multiple pouches?

The Medication Form has inventory in multiple pouches. Each pouch maintains separate inventory and must be verified independently.

Why isn't Complete and Sign Later available during a Custody Exchange?

An active Custody Exchange requires the applicable signature process to be completed before custody can be transferred.

Can I save a Custody Exchange as a draft?

The Count portion may provide Save as Draft. However, resuming the draft opens a standard medication Count rather than continuing the original Custody Exchange.

Does completing a resumed Count transfer custody?

No. Completing the resumed Count does not complete the original Custody Exchange.

Why might a Custody Exchange Override be needed after an interrupted exchange?

If the original custodian remains recorded as possessing the Med Kit and is no longer available, an authorized supervisor may need to perform a Custody Exchange Override.

Why do the signature role titles look different from another agency's workflow?

Administrators can customize signature role titles for medication events. The titles displayed during a Custody Exchange reflect your agency's configuration.

How many signatures can be required during a Custody Exchange?

Agencies can configure up to four signature roles for the event. Each role can be designated as required or optional.

Why can't I select a particular provider for a signature role?

The signature role may have Rank or Qualifier restrictions. Only personnel meeting the configured restrictions will be available for selection.

Why am I being asked for my password instead of a PIN?

When Signature and PIN validation is required, users without a configured four-digit PIN must enter their First Due account password.

Why don't I see the Fill button for my signature?

The Fill option is available when the agency permits saved profile signatures and the user has a signature saved in their First Due profile. Otherwise, the signature must be entered manually.

Why am I receiving an error when trying to save the Custody Exchange?

One or more required signatures may be incomplete. Review the signature roles at the top of the signature screen and complete all required authentication and signatures before saving.

Who becomes the recorded custodian after the exchange?

The selected Receiving Provider becomes the recorded custodian once the Custody Exchange is successfully completed and saved.