Vanderbilt University Medical Center Pharmaceutical Waste ... · PDF fileVanderbilt University...
Transcript of Vanderbilt University Medical Center Pharmaceutical Waste ... · PDF fileVanderbilt University...
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: [email protected]