Vanderbilt University

Medical Center

Pharmaceutical Waste

Program

USER INSERVICE

• This session is intended to train and provide super-users with necessary resources to effectively implement staff education.

• Stericycle is the vendor contracted by VUMC to implement and manage this program.

• Stericycle staff will provide “face-to-face” in-services throughout the hospital March 11-14 and March 17-21.

• Stericycle will support continued compliance with follow up aftercare visits.

Training and Education Plan

Why implement a

Pharmaceutical Waste

Program?

It’s the Law! Regulations require that certain discarded drugs must be managed as hazardous chemical wastes.

Regulatory Requirement

Responsible Environmental Stewardship

• Pharmaceuticals are being found in our lakes, rivers, streams, and drinking water. This contamination is associated with reproductive abnormalities in aquatic species.

• Publicly Owned Treatment Works (POTW) cannot remove pharmaceuticals.

• Incineration of pharmaceutical waste prevents leaching into ground water.

What is

Pharmaceutical

Waste?

Pharmaceutical waste is a medication that is:

• LEFT OVER or UNUSED

• Can no longer be used for its intended purpose

• Must be discarded

Pharmaceutical Waste

Examples of pharmaceutical waste include opened / unused or partially used:

• Vials

• IV’s and tubing

• Oral medications

• Ointments and Creams

Pharmaceutical Waste

Note: Unopened medications are returned to the pharmacy.

Managing

Pharmaceutical Waste

2 Basic Categories of Pharmaceutical Wastes

EPA Regulated Pharmaceutical Wastes

Non-EPA Regulated Pharmaceutical Wastes

EPA Regulated Pharmaceutical Waste

• Using the EPA regulations, Stericycle and VUMC have classified these pharmaceuticals under 4 codes to help with proper disposal:

V

B P

A

Acutely Toxic

Miscellaneous

Toxic/ Flammable

Aerosols/ Inhalers

Medications that are categorized as either B, P, A or V are identified in three ways:

1. Patient-specific medication labels

2. A pop-up window on the AcuDose RX screen

3. The EPA Regulated Pharmaceutical Waste List

Identifying EPA Regulated Pharmaceutical Wastes

B, P or A indicators are provided on patient-specific medication labels.

Indicates this drug must be disposed of as category “B” hazardous waste.

Indicates this drug must be disposed of as category “P” hazardous waste.

AcuDose RX Information

The Alert Warning in AcuDose RX indicates if the medication requires special handling as a hazardous pharmaceutical waste.

The EPA Regulated Pharmaceutical Waste List is available on edocs

List is available on edocs

and is posted in

medication supply and

storage areas.

Containers in Your Work Area

Most areas will see a set of containers like these below.

EPA Regulated

(Hazardous to Environment)

EPA Regulated Aerosols

(Hazardous in Transport)

Your work area may not need all containers shown.

Non-Regulated

Disposal of P and B Coded Pharmaceutical Wastes

Acutely Toxic Toxic/ Flammable

There are 3 P-coded medications • Warfarin • Nicotine • Physostigmine *Dispose of these items AND the packaging in the BLACK container

• Manage as a EPA Regulated Waste if the package is not empty. Empty package is NOT a regulated waste.

• Discard partially full/unused med in the BLACK container.

P and B Pharmaceutical Wastes are placed in the designated BLACK container.

B P

Seal free liquids in a zip lock bag

Disposal of A –Coded Pharmaceutical Wastes

• Separate container is required since aerosols are considered hazardous during transport.

• Examples: Asthma inhalers, Cetacaine spray

A – coded Pharmaceutical Wastes are placed in the clearly identified BLACK container with the GREEN Label.

Aerosols/ Inhalers A

Disposal of V –Coded Pharmaceutical Wastes

• A few items cannot go in Black or Blue containers due to regulations for hazardous materials transportation.

• These items are marked or coded “V” and include:

Un-used / expired Silver Nitrate sticks

• Place waste in plastic ziplock bag and call VEHS (322-0257) for pick-up

V – coded Wastes are managed by Vanderbilt Environmental Health and Safety

Miscellaneous V

NON-EPA Regulated Pharmaceutical Wastes

Discard opened / unused or partially used medications in the BLUE container when the medication is:

• NOT identified as EPA Regulated (no waste code on label / not on posted list.

• NOT a controlled substance

• NOT chemotherapy

• NOT from an isolation room

• NO sharps (needle / amp)

Seal free liquids in a zip lock bag

These wastes will NOT be disposed in the new RX waste containers

Controlled Substances

95%

95%

Waste containing blood or other body fluids; waste from isolation rooms

Follow VUMC policy CL 30-06.06

Sharps – discard in sharps containers

Chemo Waste

These wastes will NOT be disposed in the new RX waste containers

Empty IVs, vials, wrappers, and syringes will continue to be disposed of according to current procedures. An item is empty if it contains 3% or less of its original volume.

Plain down the drain

Plain IVs – Can still go down the drain. Examples include: Saline, Potassium, D5, Electrolytes, and Lactated Ringers. (No Medications Instilled)

How are the

Pharmaceutical Waste

containers managed?

Container Requirements

•EPA Regulated wastes must be stored in a medication room, soiled room or behind a nurses station.

•EPA Regulated wastes must be stored in a closed and labeled container.

•Close the containers when not in-use.

Container Management: Monday-Friday

• Stericycle technicians will be on-site Monday-Friday to pick-up the pharmaceutical waste from the Blue/Black containers.

• The Stericycle Technician will pick up the full containers and leave new empty containers in the clinical area.

Container Management: Weekends / Off-hours

• The applicable EVS group will be backup to the Stericycle Technician during off-hours and on weekends. They can be reached at

818-4199 (VUH)

936-8240 (VCH)

343-9350 (SMS/Clinics)

• All Rx waste is packaged, labeled, manifested, and shipped in compliance with DOT regulations to end disposal facilities.

REVIEW OF PROPER

DISPOSAL PRACTICES

FOR

PHARMACEUTICAL

WASTES

Narcotics Disposal – No Change to Procedures

Waste Partial Doses

DEA controlled substances

Witnessed Disposal per policy CL 30-06.06

Controlled Substance Administration & Accountability

Empty syringe & needle to sharps container.

Empty amp or vial to sharps container.

Chemotherapeutic Medication Disposal – No Change to Procedures

Chemo/Cytotoxic waste

Trace Chemo: Empty chemo vials,

empty chemo IV bags, used PPE

Waste Chemo medication:

Non-administered and partially administered

doses

Trace Chemo container

Return to Chemo pharmacy.

Chemotherapy medications are identified with a “Y” code on the label.

Message or Code Action

NO ALERT Dispose in Blue Container

A Dispose in Black Container with GREEN Label

B Dispose in Black Container

P Dispose in Black Container (Include the packaging)

V Seal in a ziploc bag and call VEHS for pick up.

Disposal of Unused Pharmaceutical Waste

DISPOSAL CODES

Seal free liquids in a zip lock bag

Non-regulated Pharmaceutical Waste

(No Acudose/EMAR Alert)

Dispose of Controlled Substances, Sharps, Chemo waste, and Plain IVs per hospital policy

No Code

Disposal of Unused Pharmaceutical Waste

This will include about 95% of the wasted pharmaceuticals.

EPA Regulated Pharmaceutical Waste

(Alerts)

SEAL IN BAG

Call VEHS for

Pickup

Disposal of Unused Pharmaceutical Waste

“P” – Unused meds & Empty

packaging

Aerosols/

Inhalers Toxic/

Flammable

Acutely

Toxic

Miscellaneous V P B A “B” –

Unused meds

Seal free liquids in a zip lock bag

For additional questions about the Pharmaceutical Waste Program

Contact Vanderbilt Environmental Health and Safety (VEHS):

Phone: 322-2057

Email: hazardouswaste@vanderbilt.edu