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Pharmaceutical Waste Management Program University of Chicago Medical Center

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Pharmaceutical Waste Management Program. University of Chicago Medical Center. Introduction. University of Chicago Medical Center (UCMC) will be implementing a program to collect Pharmaceutical (Rx) waste throughout the hospital. - PowerPoint PPT Presentation

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Page 1: Pharmaceutical Waste Management Program

Pharmaceutical Waste Management Program

University of Chicago Medical Center

Page 2: Pharmaceutical Waste Management Program

Introduction

• University of Chicago Medical Center (UCMC) will be implementing a program to collect Pharmaceutical (Rx) waste throughout the hospital.– The program has been designed to collect and manage

this waste using Best Management Procedures.

• Training Module:– This training module is designed to explain the

requirements, describe the identification process, and show how pharmaceuticals will be identified by the Pharmacy and collected in various containers in all departments of the hospital.

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Page 3: Pharmaceutical Waste Management Program

• Program Overview– Pharmacy evaluates the hospital formulary and develops

a quick and easy way (through identifiers) to indicate where to place the waste.

– Staff administers the Pharmaceutical and looks for the identifier(s) to determine where to dispose of waste.

– Staff disposes of the Pharmaceutical waste in containers placed strategically in their Unit.

– Staff will be required to know where to dispose of each type of Pharmaceutical waste.

– Staff will not be required to memorize what to do with each Pharmaceutical waste.

– Stericycle (third party) staff will be responsible for Pharmaceutical waste container service and transport.

Introduction

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Page 4: Pharmaceutical Waste Management Program

• If there are any questions regarding this new program, please see the educational postings in each unit or contact the following individuals:– Jennifer Palombizio, Manager of Safety Office

and Environmental Compliance, 2-3363, 5-SAFE or [email protected]

– Judd Johnson, Assoc. Dir – FD&C, 2-8259 or [email protected]

– If the above individuals are not available, the Pharmacy Director can be contacted

Who to Contact With Questions

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Page 5: Pharmaceutical Waste Management Program

Regulatory Environment• In addition to promoting Environmental Stewardship, there are

regulations that apply to the management and disposal of pharmaceutical wastes

• What are healthcare facilities required to do?– Manage all identified Hazardous Waste generated within the

facility (Pharmaceuticals, Lab Wastes, Engineering, Solvents, etc.). This program concentrates on the Pharmaceutical Wastes

– Some Pharmaceuticals are considered hazardous to the Environment and therefore UCMC will manage accordingly

– Rules and Regulations (EPA, IL EPA, DOT, The Joint Commission)• Federal: US Environmental Protection Agency

– Rules developed in 1976, recently began looking at Healthcare

• State: Illinois Environmental Protection Agency• Additional Regulations – Department of Transportation (when

shipping), Sewered Waste (drain disposal), The Joint Commission – Environment of Care

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Page 6: Pharmaceutical Waste Management Program

Rx waste is currently being disposed of in a variety of non-compliant ways. The table below shows some common locations where Rx waste is being disposed, what can continue to go into those containers, and what cannot.

Current Rx Waste Practices

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Rx Waste Currently Disposed of In: What Will Continue to be Disposed into Existing Container

What Will no Longer be Disposed of into Existing Container

Bio-Hazardous/Red Bag Infectious waste, gauze w/ infectious material (may contain some Rx)

IVs, vials, oral meds, wrappers, inhalers that are NOT infectious

Sharps Container Syringes and sharps Full, partial and empty Rx vials , oral meds, wrappers, inhalers

Regular Trash Garbage, outside packaging, package inserts, over wrap

Full, partial and empty Rx vials and IVs, oral meds, wrappers, inhalers, creams

Drain/Sewer Controlled substances, maintenance IV solutions, basins of irrigation solutions from ORs

Full, partial and empty Rx IVs, oral meds (except controlled substances), antibiotics

Yellow Chemo Container Empty Chemo vials and IVs, empty syringes, non-contaminated gloves & gowns

Full or partial Chemo containers (vials and IVs), Chemo spills, contaminated gloves & gowns

Page 7: Pharmaceutical Waste Management Program

• Controlled Substances Handling– Still must witness and waste to drain per DEA guidance and

written procedures

• Radioactive Rx and Nuclear Medicine Procedures– Follow existing procedures with half life decay, etc.

• Regulated Medical Waste– Sharps (needles, etc.) = Sharps Container– Red bag wastes = Red Bag/Infectious Waste Container

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

bags to the garbage• Maintenance IVs and Fluids (saline, potassium, sodium chloride, D5W,

etc.)

– If Pharmaceutical is added, then manage as it is identified

Processes Not Changing

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Page 8: Pharmaceutical Waste Management Program

Examples of Rx Waste To Collect

• Vials • IVs and tubing

– Doesn’t Include Maintenance IVs (Saline, LRs, Dextrose, KCl, Na Bicarb)

• Oral Medications• Partial syringes

• Unit dose packaging– Specifically - Coumadin unit dose

packaging, nicotine patch and backing

• Patient prescriptions– Left from patients and families

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The rules apply not only to the Rx in various forms and doses, but also applies to some containers that held the Rx. Examples of items to collect:

Page 9: Pharmaceutical Waste Management Program

• Rx can be either Hazardous or Non-hazardous to the Environment (different from OSHA Hazardous or Bio-Hazardous definitions)

• Hazardous Rx Waste – About 6% of formulary– Rx might be identified as hazardous to the environment because

it is specifically listed (Warfarin, Nicotine)– Some Rx is hazardous because the Rx has something in it

• Rx with Alcohol is Ignitable; Some Rx are Corrosive• Some Rx contain preservatives (Thimerisol) that make them

hazardous

• Non-Hazardous Rx Waste – About 93% of the formulary– Most Rx are not hazardous according to EPA definitions but many

of these Rx may still adversely affect the environment • As a best management practice, UCMC will also collect all non-

hazardous Rx and dispose through incineration

Categories of Rx Waste

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Page 10: Pharmaceutical Waste Management Program

Identifying Rx Waste Streams

• How to Identify Pharmaceuticals:– A Formulary Analysis has been completed by the

Pharmacy to identify what Rx need to be managed in which container

– Pharmacy will Identify the Hazardous Rx for disposal in Black containers

• AcuDose or EPIC MAR notification for those that are distributed through the AcuDose System

– “Dispose in Black Container”– “For Disposal Return to Pharmacy”

• Rx that has no AcuDose or MAR message or label, is Non-Hazardous and is disposed of in the BLUE Container

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Page 11: Pharmaceutical Waste Management Program

WHAT ARE THE DIFFERENT TYPES OF RX WASTE?

Sewerable WastesCompatible Hazardous Waste Incompatible Hazardous Waste (Separate)Chemotherapy WastesNon-Hazardous Waste

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Page 12: Pharmaceutical Waste Management Program

Items that can be cut and poured down the drain

•Plain IV Solutions•Solutions containing additives, such as:

Potassium chloride

Potassium phosphate

Sodium phosphate

Calcium Sodium

bicarbonate

•Controlled Substances

Place into a BAGGIE and RETURN TO PHARMACY

Place into BLACK

CONTAINER

Place into BLACK

CONTAINER

Place into YELLOW

CONTAINER

Place into BLUE CONTAINER

Incompatible Rx Wastes Require Segregation to Meet DOT, Safety & Disposal Requirements

Place in zip lock bag

Aerosols Inhalers with

canister

Oxidizers (Examples) Unused Silver

Nitrate

Corrosives (Examples)L-cysteine (in pediatric TPN)

Corrosives (Examples) Botox

Items identified with a message or black dot

Examples Insulin Some VaccinesTrace elements Coumadin Nicotine

Miscellaneous Rx Spill Cleanup

Debris Rx in Syringe –

Discharge into gauze, gauze in container, syringe to SHARPS

Chemotherapy Rx and containers that are NOT empty

Chemo AgentsIVs with Residual Chemo AgentsChemo Spill Cleanup DebrisVials with Residual Chemo AgentsTablets, caps etc.

Chemotherapy Rx and containers that ARE empty

Empty SyringesGowns with chemo small amount of contaminationGlovesGogglesWipesEmpty IVs / Tubing Vials

Not Labeled or Identified as Non-Hazardous Rx by Pharmacy

Examples

•Antibiotics•Lidocaine•Marcaine•Heparin

Miscellaneous• Full/partially filled

syringe – expel into gauze, gauze in container, empty syringe in SHARPS

Call EVS for PURPLE

CONTAINER

A Combination of Infectious Waste & Hazardous Rx Waste

ExamplesMust meet by the Hazardous and Infectious Waste Definitions

Managed like a spill response

Pharmaceutical Waste Stream ManagementPharmaceutical Waste Stream Management

Labeled or Identified as Hazardous / Incompatible Rx by Pharmacy

Hazardous Rx Waste

“Place in BLACK Container”

Non-Hazardous Rx Waste

No Messaging

Bulk & Trace Chemotherapy Rx Waste

Potentially Infectious & Hazardous Rx Waste

“Return to Pharmacy”

Sewer SystemSewer System

Cut and Discharge to

Drain

SHARPS NeedlesEmpty syringes (See Above)Empty controlled substance containers

SHARPS NeedlesEmpty syringes (See Above)Empty controlled substance containers

REGULAR TRASHOutside packaging and overwrap that did not contact RxRegular TrashShipping packaging

REGULAR TRASHOutside packaging and overwrap that did not contact RxRegular TrashShipping packaging

Incompatible Rx Waste

“Return to Pharmacy”

Page 13: Pharmaceutical Waste Management Program

SEWERABLE WASTES

Plain IV SolutionsControlled Substances

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Items that can be cut and poured down the drain

•Plain IV Solutions•Solutions containing additives, such as:

Potassium chloride

Potassium phosphate

Sodium phosphate

CalciumSodium

bicarbonate

•Controlled Substances

Sewer SystemSewer System

Cut and Discharge to

Drain

Page 14: Pharmaceutical Waste Management Program

Plain IV Solutions

• Plain IV Solutions are those prepackaged items that did not have Rx added to it

• Continue to drain Plain IV Solutions to the drain and the bags then go to the Garbage

• These Plain IV Solutions Include: Saline Lactated Ringers Potassium chloride Potassium phosphate Sodium phosphate Calcium Sodium bicarbonate

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Page 15: Pharmaceutical Waste Management Program

Controlled Substances

• Continue to follow DEA witness/waste requirements per your Hospital’s Policy

• Witness and waste to the drain, sink, toilet• Do NOT dispose controlled substances:

– In RMW containers– In Hazardous Rx waste containers– In Non-hazardous Rx waste containers, or– In Trash

• Once empty, the containers can be placed into the Sharps container or Blue Non-hazardous Rx waste container

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Page 16: Pharmaceutical Waste Management Program

COMPATIBLE HAZARDOUS RX WASTES

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Items identified with a message or black dotExamplesInsulinSome VaccinesTrace elementsCoumadinNicotine

MiscellaneousRx Spill Cleanup Debris

Rx in Syringe – Discharge into gauze, gauze in container, syringe to SHARPS

Place into BLACK CONTAINER

Hazardous Rx Waste

“Place in BLACK Container”

Page 17: Pharmaceutical Waste Management Program

Compatible Hazardous Rx Waste

• Identified with the AcuDose message or MAR message in the Label Comments, and/or on the label

• The Rx and containers having contact with Rx (vials, IVs & Tubing, etc.) placed into container (full, partials or empty)

– Specifically includes Coumadin and Nicotine Waste and Packaging

• Place in BLACK Container

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“Place in BLACK Container”

Page 18: Pharmaceutical Waste Management Program

INCOMPATIBLE HAZARDOUSRX WASTES

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Incompatible Rx Wastes Require Segregation to Meet DOT, Safety & Disposal Requirements

Place in zip lock bagAerosolsInhalers with canister

Oxidizers (Examples)Unused Silver Nitrate

Corrosives (Examples)L-cysteine (in pediatric TPN) Corrosives (Examples) Botox

Place into a BAGGIE and RETURN TO PHARMACY

Incompatible Rx Waste

“For Disposal Return to

Pharmacy”

Page 19: Pharmaceutical Waste Management Program

Incompatible Hazardous Rx Waste

• Identified with the AcuDose message or MAR message in the Label Comments, and/or on the label

• Rx Waste that cannot be collected in the same container due to EPA and DOT regulations– Examples: Aerosols (mouthpiece removed), Corrosives (Robinul),

Oxidizers (unused silver nitrate sticks), Toxins (Botox)– Bag and place in Incompatible Container

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Place in Baggie

“For Disposal Return to Pharmacy ”

Page 20: Pharmaceutical Waste Management Program

CHEMOTHERAPY WASTE

Bulk Chemotherapy Waste (Black)Trace Chemotherapy Waste (Yellow)

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A Chemotherapy Rx and containers that are NOT empty

Chemo AgentsIVs with Residual Chemo Agents

Chemo Spill Cleanup Debris

Vials with Residual Chemo Agents

Tablets, caps etc

Place into BLACK CONTAINER

Chemotherapy Rx and containers that ARE empty

Empty SyringesGowns with chemo small amount of contamination

GlovesGogglesWipesEmpty IVs / Tubing

Empty Vials

Bulk & Trace Chemotherapy Rx Waste

Place into YELLOW CONTAINER

Page 21: Pharmaceutical Waste Management Program

TRACE Chemotherapy

• “Trace” Chemotherapy Waste is any EMPTY Chemotherapy Container (YELLOW)– Empty IVs and tubing – Syringes– Non-contaminated PPE

• Gowns, Goggles, Gloves• Wipes

– Place these items into the YELLOW Container that is currently being used

• Yellow Containers will be located on units that consistently use Chemotherapy items

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Page 22: Pharmaceutical Waste Management Program

BULK Chemotherapy

• “Bulk” Chemotherapy Waste is any chemotherapy Rx that is NOT empty– Non-empty containers holding free liquid (vial, IV

bag, tubing)• Oral medications – Patient refused, medication

dropped, etc.• Discontinued Rx – Patient reaction, partial IV

– Overtly contaminated garments and spill clean up material

• Gowns, Goggles, Gloves• Spill cleanup (Rags, Wipes, Towels)

– Place into BLACK Container22

Page 23: Pharmaceutical Waste Management Program

NON-HAZARDOUS RX WASTE

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Not Labeled or Identified as Non-Hazardous Rx by Pharmacy

Collect Full and Partially Full Rx Containers

Examples•Antibiotics•Lidocaine•Marcaine•HeparinMiscellaneous

Place into BLUE CONTAINER

Non-Hazardous Rx Waste

No Messaging

Page 24: Pharmaceutical Waste Management Program

Non-Hazardous Rx Waste

• Identified with the AcuDose message or MAR message in the Label Comments, and/or on the label

• Managed by placing waste into BLUE Container– Majority of Rx will be Non-hazardous - therefore

no label

NO LABEL or

IDENTIFIER24

Page 25: Pharmaceutical Waste Management Program

Regular Trash

• Items that can be disposed of in the regular Trash include:– Outside packaging and package inserts– Cardboard– Plain IVs and Tubing

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Page 26: Pharmaceutical Waste Management Program

GENERAL REQUIREMENTS

Containers – Closed and LabeledMovement of Full ContainersSpill Response

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Page 27: Pharmaceutical Waste Management Program

Container Requirements

• The hazardous waste containers (Black) must be stored in a closed and labeled– Close the containers when

not using them– The label must have at least

the words “Hazardous Waste”, a description of the contents, and the date that the container was filled (completed by Stericycle)

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PHARMACEUTICAL HAZARDOUS WASTE START DATE _____________________________

CONTAINER FULL DATE ___________________

PHARMACEUTICAL HAZARDOUS WASTE START DATE _____________________________

CONTAINER FULL DATE ___________________

Page 28: Pharmaceutical Waste Management Program

• Rx Waste Containers must be under the control of the staff; therefore they will be generally located in centralized areas in each unit such as the Soiled Utility Rooms or in or near Med Rooms or Procedure Rooms

• The full containers will be managed like the Sharps Containers and picked up by Stericycle Technician

Movement of Containers

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Page 29: Pharmaceutical Waste Management Program

Spill Response

• Refer to facility Spill Response Policy, which includes the following:– Call Spill Team– Secure Area– Identify Material & get MSDS– Contain and Clean-up as directed by Spill

Team• Spill Kits, Absorbents

– Dispose of Hazardous Clean-up Materials Properly

• Hazardous Waste Container29