Pharmaceutical Waste Management Program

St. Joseph Mercy Oakland

Pharmacy/Patient Care

Objectives

• Understand the background and regulatory requirements

• Identify pharmaceutical waste and how to dispose• Identify the different pharmaceutical waste

containers and what goes in each• Define Oncology Pharmaceuticals• Describe how to label waste handling containers

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–BACKGROUND AND REGULATORY REQUIREMENTS

250 million pounds of pharmaceutical waste disposed is from hospitals and long-term care centers annually, most of which ends up in our waterways. There are many rules and regulations regarding pharmaceutical waste management.

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Background– In 1999-2000 a US Geological Survey tested 139 rivers in

30 states and found that over 80% of stream samples showed evidence of prescription and non-prescription drugs, antibiotics, steroids and hormones.

– Hospitals are under the close watch of the Michigan Department of Environmental Quality (DEQ) and the Environmental Protection Agency (EPA) to follow laws governing proper pharmaceutical waste disposal.

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Associate Training• Associates must be trained if handling

hazardous waste– Employees whose responsibilities include hazardous waste

management, storage, transport, or recordkeeping require hazardous waste training.

– Employees must receive initial training within six months of the date of their employment or a change in job requirements.

• Annual training required thereafter

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WHAT IS PHARMACEUTICAL (RX) WASTE?

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Black containers in the medication room and in the soiled utility will be used for:

• All medication EXCEPT: incompatible drugs• No Controlled Substances and sharps are NOT to be put in

black containers • Unused IV drug solutions• Tablets and capsules• Partial vials• Partial vaccine vials• Nicotine, Warfarin & Nitroglycerin wrappers

Pharmaceutical (Rx) Waste

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• All Pharmaceutical Canisters/ Inhalers/ Aerosols• The items listed below must be sent home with

patient or returned to pharmacy:• Albuterol• Dermoplast• Symbicort• Atrovent• Combivent

Incompatible Drugs

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Incompatible waste sent back to pharmacy

• These items must be returned to pharmacy:

• Amyl nitrate• Granulex• Silver nitrate (unused)• Cyanide Antidote Kit• Cortisporin Otic

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Bulk Chemotherapy Waste

BULK • Chemotherapy containers with

residue, including oral chemotherapy containers

• Partial chemotherapy• IV bags, tubing and vials• Chemotherapy Spill Clean Up

Kit• Contaminated gloves, goggles,

gowns

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Trace Chemotherapy Waste

TRACE• Non Contaminated:• Empty Chemotherapy

vials, syringes, needles, IVs, tubing

• Personal Protective Equipment (PPE) used to prepare or administer chemotherapy

Dual Waste• Infectious and hazardous waste

– Pharmaceuticals that are both infectious and hazardous waste cannot be disposed of in “red bags” due to hazardous constituent. Put these in the black containers. For example: a soiled dressing that has a medication on it.

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• Regulated Medical Waste– Sharps containers (needles, etc.)– Red bag wastes

• Controlled Substances– Witness and waste to drain

• IV – Can still cut and drain non-pharmaceuticals to the

drain• Maintenance IVs and Fluids (saline, dextrose, etc.)

Not Hazardous Waste

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Sharps containersSharps containers:• All empty sharps, needles and ampoules• Lancets & scalpels• Empty vaccine vials/syringes• Broken glass ampoules• IV catheters, stylets, butterflies• Disposable suture scissors

Disposed in sink or toilet• All controlled substances- injections, infusions• Oral controlled medication -solids crush and flush• Patches of controlled medications -fold and flush • Cut and drain

– Maintenance electrolyte IV solutions (sodium, potassium, magnesium)– Dextrose IV solutions WITHOUT medication instilled:

• Potassium chloride• Potassium phosphate• Sodium phosphate• Calcium• Sodium bicarbonate• Dextrose • Saline

Waste HandlingMovement of ContainersSpill Response

Container Requirements

• Hazardous (Universal) wastes must be stored in a closed and labeled container. – The label must have at least

the words “Universal Waste”, a description of the contents, and the dates that the container was both started and filled.

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Protect Yourself

Always protect yourself when handling wastes:

•Wear proper Personal Protective Equipment (PPE) such as gloves• Make sure that containers are tightly sealed before moving them• Hold containers or liners away from your body when moving them

• The containers will be transported to the Hazardous Waste Storage Area when full by Environmental Services (EVS).

• A new empty container will replace the removed container. – When assembling the containers, ensure the lid is

securely fastened and absorbent is placed into bottom of container.

Movement of Containers

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• ALWAYS CHECK to make certain that the container is closed prior to moving it.

• Always move containers in an upright position to prevent spills and leaks.

Movement of Containers

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Spill Response• If there is a spill of hazardous wastes:

– Notify Environmental Services– Secure Area– Identify Material– Contain and Clean-up if safe to do so

• Spill Kits, Absorbents– Dispose of Hazardous Clean-up Materials Properly

• Hazardous Waste Container

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Pharmaceutical Wastes

• Don’t know where to put it? Black container, or drain? Contact Pharmacy Ext. 83054