Purpose Statement
This article explains how to complete a Custody Exchange for a controlled substance Med Kit. A Custody Exchange documents the transfer of possession from one provider to another and creates a historical record of who relinquished and accepted custody.
Depending on agency configuration, the workflow can include seal verification, a physical medication count, pouch-level inventory verification, occurrence documentation, and signatures from both the transferring and receiving providers. Users who will continue possessing the Med Kit can instead document that they are retaining custody.
Access to Custody Exchange controls depends on the Med Kit configuration, the agency's Exclusive Possession setting, the current custody holder, and the user's permissions.
Background Information
Custody Exchange is available for Med Kits configured for controlled substances. Non-controlled substance Med Kits do not display the Custody Exchange option.
Who can initiate a Custody Exchange depends on the agency's Exclusive Possession configuration:
- When Exclusive Possession is enabled in Medications > Setup, only the user currently recorded as having possession can initiate a standard Custody Exchange. Users who do not have possession do not see the Custody Exchange controls when viewing the Med Kit unless they have Override Exclusive Possession permission. Users performing a custody override also need Possession Override permission.
- When Exclusive Possession is disabled, a user who does not currently have possession must have Meds - Global Custody Exchange permission to initiate the Custody Exchange.
The Medications Dashboard has an additional limitation. When Exclusive Possession is enabled, the Start Exchange button is not displayed for selected Med Kits on the Dashboard. When Exclusive Possession is disabled, users must have Meds - Global Custody Exchange permission for Start Exchange to appear.
The user who initiates the standard Custody Exchange is documented as the Transferring Provider. For this reason, the appropriate provider should initiate the exchange.
For Med Kits using seals, users begin by entering the physical seal number. If the seal matches the value recorded in the system, the providers can proceed with the custody transfer without breaking the seal or can choose Break and Count. If the seal does not match, Break and Count is required by the First Due workflow so the available medication inventory can be physically verified before custody is transferred.
When a count is performed, medications are verified at the pouch level. If the same Medication Form has available inventory in multiple pouches, the inventory in each pouch is displayed and verified separately.
Medication Forms configured in the Med Kit with a current quantity of 0 do not display during the Count portion of a Custody Exchange because there is no physical inventory to verify. The Medication Form remains visible when viewing the Med Kit but is unavailable for medication actions until inventory is received or transferred into the applicable pouch.
Unlike a standard medication event, an active Custody Exchange does not provide Complete and Sign Later. The transferring and receiving providers complete the applicable signature process as part of the active exchange.
Required Permissions
Users need the applicable permissions and access for the Custody Exchange functions they need to perform:
- Med Kits — Access to applicable Med Kits.
- Meds - Custody Exchange — Allows applicable Custody Exchange functionality.
- Meds - Global Custody Exchange — Required when Exclusive Possession is disabled for a user who does not currently have possession to initiate a Custody Exchange. This permission also controls access to Start Exchange on the Medications Dashboard when Exclusive Possession is disabled.
- Override Exclusive Possession — Allows an authorized user to access custody controls for a Med Kit possessed by another user when Exclusive Possession is enabled.
- Possession Override — Allows an authorized user to override the existing custody possession.
- Applicable Dashboard access when working from the Medications Dashboard.
Signature and authentication requirements depend on agency configuration.
Important Note:
Override Exclusive Possession and Possession Override serve different purposes. A user who needs to override another user's custody when Exclusive Possession is enabled requires the applicable override access described above.
Video
Medications Par Management
Par management allows medication inventory within a Med Kit to be organized and monitored at the pouch level. When a Custody Exchange requires Break and Count, each pouch containing available medication inventory is displayed separately for physical verification.
If the same Medication Form has inventory in multiple pouches, users verify the available inventory associated with each pouch separately. This helps personnel distinguish the physical location of inventory being transferred into the receiving provider's custody.
Medication Forms with a current quantity of 0 do not display during the Count portion of a Custody Exchange because there is no physical medication inventory to count or verify. They remain visible when viewing the Med Kit but are unavailable for medication actions until inventory is added.
Medication cards use the following current inventory-status logic:
- Red — Restock Needed: Available quantity is below Min.
- Yellow — Monitor: Available quantity is at Min or above Min and at or below Par.
- Yellow — Monitor when Min is not configured: Available quantity is at or below Par.
- Light Gray — Well Stocked: Available quantity is above Par.
- Light Gray — No applicable Par threshold: When Par is not configured, inventory above Min appears light gray.
- Light Gray — No thresholds configured: When neither Par nor Min is configured, the medication card appears light gray.
Par and Min are inventory-status references and do not replace physical verification during a Custody Exchange.
A Medication Form at quantity 0 does not appear during the Count portion of a Custody Exchange, even when it remains visible on the Med Kit Overview as a red Restock Needed card. Custody Exchange Counts display only medication inventory that is physically present and available to verify.
Par and Min values are optional. During a Custody Exchange Count, use the displayed inventory status as additional context while physically verifying the medication actually present.
Step-by-Step Guide
1. Determine Where to Start the Custody Exchange
A Custody Exchange may be initiated from the Medications Dashboard or directly from the applicable controlled substance Med Kit, depending on agency configuration and user permissions.
Before beginning, confirm that the appropriate provider is initiating the exchange.
Warning:
The user who initiates the standard Custody Exchange is documented as the Transferring Provider. The appropriate person should initiate the Custody Exchange so the resulting custody record accurately represents the transfer that occurred.
2. Start a Custody Exchange from the Dashboard
Open the Medications Dashboard.
When the Scheduling module is used, the Dashboard may automatically display Med Kits associated with the user's current assignment. Use the Items selection to review other applicable Med Kits when needed.
When available, select Start Exchange for the applicable controlled substance Med Kit.
Whether Start Exchange appears depends on the agency's custody configuration:
- When Exclusive Possession is enabled, Start Exchange is not displayed for selected Med Kits on the Dashboard.
- When Exclusive Possession is disabled, the user must have Meds - Global Custody Exchange permission for Start Exchange to appear.
3. Start a Custody Exchange from Med Kits
From the Medications module:
- Select Med Kits.
- Select the applicable controlled substance Med Kit.
- Review the available Custody Exchange controls.
When Exclusive Possession is enabled:
- The user currently recorded as having possession can initiate the standard Custody Exchange.
- Users who do not have possession do not see the Custody Exchange controls unless they have Override Exclusive Possession permission.
- Users who need to override the existing custody possession also need Possession Override permission.
When Exclusive Possession is disabled, a user who does not currently have possession must have Meds - Global Custody Exchange permission to initiate the exchange.
Important Note:
The Custody Exchange option is only available for applicable controlled substance Med Kits. A Med Kit configured as non-controlled substance does not display the Custody Exchange option.
4. Choose Custody Exchange or Retain Custody
When starting the workflow, choose the action that reflects what is physically occurring:
- Custody Exchange — Transfer possession of the controlled substance Med Kit from one provider to another.
- Retain Custody — Document that the current provider will continue possessing the Med Kit.
- Cancel — Exit without starting the custody workflow.
Select Custody Exchange when another provider is taking possession.
Custody Exchange - Non-Possession Holder
Retain Custody - Possession Holder
When the current provider will continue possessing the controlled substance Med Kit, start the applicable custody workflow and select Retain Custody instead of Custody Exchange.
Select the applicable retention reason:
- Operational
- Shift / Staffing
- Administrative
- Emergency / Contingency
- Other
Enter applicable comments. When Other is selected, a comment is required.
Select Retain Custody and complete the applicable authentication and signature process.
The current provider remains recorded as having custody.
5. Enter the Current Seal Number
For a controlled substance Med Kit configured to use seals:
- Enter the seal number physically present on the Med Kit.
- Select the Plus (+) control.
- Select Save.
The system compares the entered seal number with the seal currently recorded for the Med Kit.
6. Continue When the Seal Matches
When the physical seal matches the seal recorded in the system, choose the applicable option:
- Proceed to Sign and transfer possession without breaking the seal.
- Select Break and Count to break the seal and physically count the medication inventory before transferring custody.
Follow agency policy when determining whether to proceed with the matching seal or perform a physical count.
7. Break and Count When the Seal Does Not Match
If the physical seal does not match the seal recorded in the system, the First Due workflow requires Break and Count.
Break the seal and proceed with physical inventory verification before transferring custody.
8. Review the Pouches and Available Inventory
After selecting Break and Count, review the pouches and medication inventory displayed in the workflow.
When the same Medication Form has available inventory in multiple pouches, verify each pouch separately.
Important Note:
Medication Forms with a current quantity of 0 do not display during a Custody Exchange Count. Because there is no physical medication inventory to count or verify, the zero-quantity Medication Form is excluded from the event.
The Medication Form remains visible when viewing the Med Kit so personnel can identify that it needs inventory, but it is unavailable for medication actions until medication is received or transferred into the applicable pouch.
9. Review Medication Details
Select each applicable medication card to review its available inventory.
Depending on configuration and the inventory being tracked, details can include:
- Medication Form
- Quantity
- Expiration date
- Lot number
- Serial number
If multiple Medication Forms contain available inventory, select the applicable medication card to review the individual forms and inventory records.
10. Verify the Medication Inventory
Physically compare the medications in each displayed pouch with the inventory recorded in First Due.
Use the available verification controls:
- Select the Thumbs Up indicator when the physical medication is present and matches the expected inventory.
- Select the X indicator when a discrepancy exists.
Continue until all required available inventory has been verified.
11. Review Par and Min Status
When inventory-status information is displayed, use it as an additional reference while reviewing the medication.
Under the current inventory color logic:
- Yellow indicates inventory is at Min or otherwise within the applicable Par monitoring range.
- Red — Restock Needed indicates available inventory has dropped below Min.
- Light gray generally indicates inventory is above Par or no applicable Par threshold is currently producing a monitoring condition.
Par and Min indicators do not replace physical verification.
12. Document Medication Discrepancies
If medication is missing or does not match the expected inventory, select the X indicator.
For controlled substances, applicable discrepancies can generate an Occurrence Issue and provide occurrence-reporting options.
An Occurrence Issue identifies that the physical inventory documented during the Count differs from the expected inventory. It does not determine why the discrepancy occurred or assign responsibility.
Follow agency procedures and review the associated medication history when additional investigation is needed.
13. Avoid Saving the Custody Exchange as a Draft
After completing the Count portion, Save as Draft may be available.
For normal Custody Exchange workflows, avoid using Save as Draft unless an operational interruption prevents completion.
When the Count portion of a Custody Exchange is saved as a draft and later resumed, it resumes as a standard medication Count. It does not resume the original Custody Exchange.
Completing the resumed Count therefore does not transfer custody to the intended receiving provider.
Whenever possible, keep both providers available and proceed directly through the Custody Exchange signature process.
14. 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.
Warning:
If Exclusive Possession is enabled, the existing provider remains the recorded custodian after the Custody Exchange is interrupted. If that provider is no longer available, an authorized user may need to use the Custody Exchange Override workflow.
15. Select Sign and Finish
For an uninterrupted Custody Exchange, select Sign and Finish after all required available inventory has been verified.
Complete and Sign Later is not available during an active Custody Exchange.
Both providers should remain available to complete the custody transfer.
16. Enter the New Seal Number
When the Med Kit requires seals:
- Apply the new physical seal.
- Enter the new seal number.
- If multiple seals are required, enter each applicable seal number.
- Select the Plus (+) control.
- Select Sign.
The workflow proceeds to the Custody Exchange signature process.
17. Complete the Transferring Provider Signature
The user who initiated the standard Custody Exchange is documented as the Transferring Provider.
Complete the agency-configured authentication and signature requirements.
Depending on configuration, this can include:
- PIN
- First Due account password
- A signature filled from the user's profile
- A manually entered signature
18. Complete the Receiving Provider Signature
Select the Receiving Provider who is taking possession of the controlled substance Med Kit.
The receiving provider completes the applicable authentication and signature requirements.
After both providers complete their requirements, select Save to finalize the Custody Exchange.
The receiving provider is then recorded as having custody of the Med Kit.
Best Practices
- Confirm that the appropriate provider initiates the Custody Exchange because the initiating user is documented as the Transferring Provider.
- Understand how the agency's Exclusive Possession setting affects who can initiate or override a Custody Exchange.
- Ensure users who perform custody overrides have the applicable Override Exclusive Possession and Possession Override permissions.
- Use Meds - Global Custody Exchange appropriately when Exclusive Possession is disabled and users need to initiate an exchange without currently possessing the Med Kit.
- Ensure the transferring and receiving providers are available before beginning the exchange.
- Plan to complete the Custody Exchange and signatures in the same session whenever possible.
- Avoid Save as Draft during a Custody Exchange. A resumed draft becomes a standard Count and does not complete the intended custody transfer.
- Verify physical seal numbers carefully before proceeding with the matching-seal option or Break and Count.
- Physically verify all medication inventory displayed during a Break and Count.
- Remember that zero-quantity Medication Forms do not display during a Custody Exchange Count because there is no physical inventory to verify.
- Review each pouch independently when the same Medication Form has inventory in multiple pouches.
- Treat Par and Min colors as inventory-status indicators rather than substitutes for physical verification.
- Remember that at Min is yellow; below Min is red Restock Needed.
- Review controlled substance discrepancies and Occurrence Issues in context with the associated medication activity.
- Confirm the new seal information and receiving provider before finalizing the exchange.
- Use Retain Custody when the current provider will continue possessing the Med Kit rather than documenting a transfer that did not occur.
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 the Med Kit do not see the Custody Exchange controls unless they have Override Exclusive Possession permission. An authorized custody override also requires Possession Override.
Why don't I see Start Exchange on the Medications Dashboard?
When Exclusive Possession is enabled, Start Exchange is not displayed for selected Med Kits on the Dashboard. When Exclusive Possession is disabled, you must have Meds - Global Custody Exchange permission for Start Exchange to appear.
Why can I see a Med Kit on my Dashboard but not Start Exchange?
Seeing or selecting a Med Kit on the Dashboard does not automatically provide permission to initiate its Custody Exchange. Review the agency's Exclusive Possession setting and your Meds - Global Custody Exchange permission.
Can I use Start Exchange on the Dashboard when Exclusive Possession is enabled?
No. When Exclusive Possession is enabled, Start Exchange is not displayed on the Medications Dashboard.
Who can initiate a Custody Exchange when Exclusive Possession is enabled?
The user currently recorded as possessing the Med Kit can initiate the standard Custody Exchange. A user who does not have possession does not see the Custody Exchange controls unless they have Override Exclusive Possession permission. Overriding the existing custody possession also requires Possession Override.
Who can initiate a Custody Exchange when Exclusive Possession is disabled?
The current custodian can initiate the applicable exchange. A user who does not have possession must have Meds - Global Custody Exchange permission to initiate it.
Does Meds - Global Custody Exchange override Exclusive Possession?
No. Meds - Global Custody Exchange applies when Exclusive Possession is disabled. When Exclusive Possession is enabled, access for a user who does not possess the Med Kit is controlled through the applicable exclusive-possession and custody-override permissions.
What is the difference between Override Exclusive Possession and Possession Override?
Override Exclusive Possession allows an authorized user to access custody controls when another user possesses the Med Kit under Exclusive Possession. Possession Override allows the authorized user to override the existing custody possession.
Who is documented as the Transferring Provider?
The user who initiates the standard Custody Exchange is documented as the Transferring Provider. Confirm that the appropriate person initiates the workflow.
What happens if the seal matches?
When the physical seal matches the seal recorded in First Due, the workflow can proceed to the custody signature process without breaking the seal, or the user can select Break and Count.
What happens if the seal does not match?
The First Due workflow requires Break and Count so the physical medication inventory can be verified before the exchange continues.
Do I need to count medications during every Custody Exchange?
Not necessarily. A seal-secured Med Kit with a matching seal can allow the exchange to proceed without breaking the seal. When Break and Count is selected or required, the available physical inventory must be verified.
Why doesn't a zero-quantity Medication Form appear during the Custody Exchange Count?
Medication Forms with a current quantity of zero are not displayed during a Count or Custody Exchange because there is no physical inventory to verify. The Medication Form remains visible when viewing the Med Kit but is unavailable for medication actions until inventory is received or transferred into the applicable pouch.
Why do I see the same Medication Form in multiple pouches during the Count?
The Medication Form has available inventory in multiple pouches. Each pouch maintains its own inventory and is verified separately.
Why is a medication yellow when its quantity equals Min?
Under the current inventory-status logic, inventory at Min is yellow. The red Restock Needed condition begins only when available inventory drops below Min.
When does a medication display Restock Needed?
The medication card displays red Restock Needed when available inventory is below the configured Min.
Why isn't Complete and Sign Later available?
An active Custody Exchange requires the transferring and receiving providers to complete the applicable custody signature process. It cannot be finalized as a pending signature using Complete and Sign Later.
Can I save a Custody Exchange as a draft?
The Count portion can provide Save as Draft, but doing so is not recommended for a normal Custody Exchange. When resumed, the workflow becomes a standard medication Count rather than resuming the Custody Exchange.
Why does Complete and Sign Later appear after I resume a Custody Exchange draft?
The saved workflow has resumed as a standard Count, not as the original Custody Exchange. Standard Count completion options therefore apply.
Does completing the resumed Count transfer custody?
No. Completing the resumed standard Count does not complete the original custody transfer.
Why might a Custody Exchange Override be needed after an interrupted exchange?
When Exclusive Possession is enabled, the existing provider remains the recorded custodian after an interrupted Custody Exchange. If that provider is no longer available, an authorized user may need to use Custody Exchange Override to change the custody assignment.
What happens if Exclusive Possession is disabled and another Custody Exchange is started after the original exchange was saved as a draft?
The initiating user can be documented as the Transferring Provider even if that person was intended to receive custody. Verify the provider roles before completing the new exchange.
What happens if medication is marked with an X during the Count?
A controlled substance discrepancy can create an Occurrence Issue and provide applicable occurrence-reporting behavior. The Occurrence Issue identifies the discrepancy but does not determine its cause. Review the associated inventory and medication history according to agency procedures.
When should I use Retain Custody?
Use Retain Custody when the current provider will continue possessing the controlled substance Med Kit instead of transferring possession 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.