Pharmaceutical Waste Disposal Program...pharmaceutical waste disposal program to ensure that we are...
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Pharmaceutical Waste Disposal Program Welcome to the Baptist Health University online tutorial for the Baptist Health Pharmaceutical Waste Disposal Program
Pharmaceutical Waste Disposal Program...pharmaceutical waste disposal program to ensure that we are doing our part to preserve the environment. Baptist Health’s commitment to the
Define RCRA. Identify the four characteristics of RCRA hazardous waste. Be able to properly identify which waste stream belongs in the
various colored bins. List the regulatory agencies that mandate this important program. Determine what to do in the event of a spill (Code White)?
Understand the process of a medication disposal from pharmacy to the final point of disposal.
By the end of this session, you should be able to:
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Presentation Notes
By the end of this session, you should be able to: 1).Define RCRA. 2).Identify the four characteristics of RCRA hazardous waste. 3).Be able to properly identify which waste stream belongs in the various colored bins. 4).List the regulatory agencies that mandate this important program. 5).Identify the procedure of what to do in the event of a spill (Code White)? 6).Sequence the process of a medication disposal from pharmacy to the final point of disposal.
Overview “Greening Our Future”
In order to give you a brief overview of why Baptist Health has implemented the Pharmaceutical Waste Disposal Program, we have created this online learning tool to show you how this program ties into Baptist Health’s continued focus on best management practices. Baptist Health has always strived to be a leader in the community and is constantly looking for process improvements and ways to become more environmentally sound. Baptist Health has developed a comprehensive pharmaceutical waste disposal program to ensure that we are doing our part to preserve the environment. Baptist Health’s commitment to the community involves the impact our facilities make on the ecosystem in South Florida. This program is an important part of “Greening Our Future.”
Presenter
Presentation Notes
In order to give you a brief overview of why Baptist Health has implemented the Pharmaceutical Waste Disposal Program, we have created this online learning tool to show you how this program ties into Baptist Health’s continued focus on best management practices. Baptist Health has always strived to be a leader in the community and is constantly looking for process improvements and ways to become more environmentally sound. Baptist Health has developed a comprehensive pharmaceutical waste disposal program to ensure that we are doing our part to preserve the environment. Baptist Health’s commitment to the community involves the impact our facilities make on the ecosystem in South Florida. This program is an important part of “Greening Our Future.”
Our Goal • To educate BHSF staff in the proper handling and disposal procedures of both hazardous and non-hazardous medications.
• To ensure that BHSF staff is disposing of pharmaceutical waste in compliance with federal Environmental Protection Agency (EPA), Florida Department of Environmental Protection (FL DEP), Department of Transportation (DOT), Occupational Safety and Health Administration (OSHA), and The Joint Commission (TJC) regulations.
Presenter
Presentation Notes
Our goal is to educate BHSF staff in the proper handling and disposal procedures of both hazardous and non-hazardous medications. We also want to ensure that BHSF staff is disposing of pharmaceutical waste in compliance with federal Environmental Protection Agency (EPA), Florida Department of Environmental Protection (FL DEP), Department of Transportation (DOT), Occupational Safety and Health Administration (OSHA), and The Joint Commission (TJC) regulations. There are various waste streams within the hospital and as always, there are a few outliers so pay close attention.
Resource Conservation & Recovery Act
In 1976, the Resource Conservation and Recovery Act (RCRA) was enacted by the Environmental Protection Agency (EPA). Initially they focused on the oil and chemical industries but with recent studies of our water supply being conducted, they have shifted their focus to include the biggest generator of pharmaceutical waste - hospitals.
This law regulates the disposal of solid wastes and encourages the minimization of waste generation. It defines "hazardous waste" and
it requires its tracking, from "cradle to grave."
Presenter
Presentation Notes
In 1976, the Resource Conservation and Recovery Act was enacted by the Environmental Protection Agency or EPA for short. Initially, they focused on the oil and chemical industries but with recent studies of our water supply being conducted, they have shifted their focus to include the biggest generator of pharmaceutical waste - hospitals. This law regulates the disposal of solid wastes and encourages the minimization of waste generation. It defines “hazardous waste” and it requires its tracking from cradle to grave.
RCRA Hazardous Waste RCRA Hazardous Waste is defined as wastes that EPA has determined as hazardous. The lists include the F-list (wastes from common manufacturing and industrial processes), K-list (wastes from specific industries), and P- and U-lists (wastes from commercial chemical products).
Also any medication waste that exhibits one or more of these characteristics:
RCRA Hazardous Waste is defined as wastes that EPA has determined are hazardous. The lists include the F-list (wastes from common manufacturing and industrial processes), K-list (wastes from specific industries), and P- and U-lists (wastes from commercial chemical products). Also any medication waste that exhibits one or more of these characteristics: Toxicity Reactivity Ignitability (Flammables) Corrosivity
The Surveyors Found. . .
In 2002, the U.S. Geological Service conducted the first nationwide reconnaissance of the occurrence of pharmaceuticals, hormones and other organic wastewater contaminants in 139 American streams. Of the 95 contaminants screened for, one or more were found in 80% of the samples and the majority of the contaminants were pharmaceuticals. This finding launched an aggressive federal initiative to survey hospitals to ensure they have a pharmaceutical waste disposal program in place that complies with all requirements of RCRA.
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Presentation Notes
In 2002, the U.S. Geological Service conducted the first nationwide reconnaissance of the occurrence of pharmaceuticals, hormones and other organic wastewater contaminants in 139 American streams. Of the 95 contaminants screened for, one or more were found in 80% of the samples and the majority of the contaminants were pharmaceuticals. This finding launched an aggressive federal initiative to survey hospitals to ensure they have a pharmaceutical waste disposal program in place that complies with all requirements of RCRA.
How Does It IMPACT Us?
There is currently no mechanism or technology in place that filters out pharmaceutical waste. This is the water that we drink, cook with and shower in DAILY.
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Presentation Notes
How does it impact us? Unfortunately, there is currently no mechanism or technology in place that filters out pharmaceutical waste from our water supply. This is the water that we drink, cook with and shower in DAILY.
Two tadpoles after 57 days of development in the lab. The one on the right, which has yet to sprout limbs, was exposed to Fluoxetine, also known as Prozac.
Another eye opening impact that has caught everyone’s attention is the study done with these two tadpoles. After fifty-seven days in the lab, the one on the right did not develop his limbs while exposed to Fluoxetine, the generic of Prozac. The one on the left in clean water developed normally. Now imagine the impact that this will have as a fish can now eat that tadpole that didn’t develop. . . and as humans consume the fish, we are increasing the methods by which we ingest pharmaceutical waste.
How Is Waste Currently Disposed?
Blood Bags and Biohazardous Waste
Sharps
Pharmaceutical Waste Items
Sharps Containers Red Bags
• Returns Medications to Pharmacy through Reverse Distributor
Eligible for return? Leftover/Waste (Not eligible for return)
• Landfills • Pipelines/
Sewers Continue following the sharps procedure. All containers should be handled like a sharps container to avoid a needle stick. Nobody should ever reach in a bin to retrieve anything.
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So what can we do about this? Well, if you look at the way pharmaceutical waste is currently being disposed of, we must make some changes. There are various waste streams that are generated at the hospital. Let’s review to see what we can do to help. . . Biohazardous waste will continue to be disposed of in the red bio-hazardous bags. Remember, biohazardous waste is defined as blood bags and any other material that is heavily saturated with bodily fluids and must be disposed of in the red bins. All needles must continue to be disposed of in the sharps containers which are located in each patient’s room and in the medication preparation areas. We would never want to pose the threat of a needle stick so be sure to follow your hospital policy on disposal of needles. Leftover pharmaceuticals or medication waste has been disposed of in our landfills and into our sewage lines. Unused IV bags can no longer be dumped into the sinks because its greatly affecting our water supply in which we shower, eat and drink.
Pharmacy Staff’s Role The Pharmacy staff’s role is to identify the RCRA hazardous medications. They will label these meds with a purple dot and they will be placed inside the plastic zip-top bag with the purple label that reads “DISCARD IN PURPLE BIN” before dispensing to the nursing unit.
This takes the guess work out of the equation to simplify things for nursing as
much as possible.
Presenter
Presentation Notes
The Pharmacy staff’s role is to identify the RCRA hazardous medications. They will label these meds with a purple dot and they will be placed inside the plastic zip-top bag with the purple label that reads “DISCARD IN PURPLE BIN” before dispensing to the nursing unit. This takes the guess work out of the equation to simplify things for nursing as much as possible.
Identifying Medications for Proper Disposal
All medications colored-coded with purple dot labels must be disposed of in the purple bin.
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Please make sure that if you received the medication in a plastic zip-top bag with a purple “DISCARD IN PURPLE BIN” label on it, you do not return your plastic zip-top bags to pharmacy for re-use. This could cause cross-contamination and would be considered an Infection Control issue. If it comes in a bag, it leaves in a bag. Medications are characterized by their NDC # or National Drug Code and not necessarily by the medication name. Trust that your pharmacy staff has taken the proper precautions to label the appropriate medications.
Three Bins? White bins and purple bins with will be placed on
each nursing unit. A smaller black jug will also be used to capture
pressurized aerosols or silver nitrate sticks.
Check with your nursing leadership for the exact location on your unit.
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Presentation Notes
There are three bins. . . White bins and purple bins will be placed on each nursing unit. A smaller black jug will also be used to capture pressurized aerosols or silver nitrate sticks. Check with your nursing leadership for the exact location on your unit.
Pyxis Pharmacy staff will label
hazardous medications with purple dots in the pharmacy prior to loading into Pyxis.
Any tablets with purple dots that have been opened and cannot be returned for credit must be disposed of in the purple bin.
If the patient refuses the medication or if the pill or tablet was accidentally dropped on the floor, it must also be thrown into the purple bin if it has the purple dot. All other medications can be
disposed of in the white bin.
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Presentation Notes
Pharmacy staff will label of hazardous medications with purple dots in the pharmacy prior to loading into Pyxis. Any tablets or pills labeled with purple dots that have been opened and cannot be returned for credit must disposed of in the purple bin. If the patient refuses the medication or if the pill or tablet was accidentally dropped on the floor, it must also be thrown into the purple bin if it has the purple dot. All other medications can be disposed of in the white bin.
What Goes In the Purple Bin? • Hazardous Pharmaceutical Waste regulated by the Environmental Protection Agency (EPA).
• Any medications or container (IV bags, vials) that are delivered from pharmacy in a plastic zip top bag with a purple label on it must be placed back in the bag and sealed. Liquid from discontinued IV bags must be contained in another plastic bag before being discarded in the purple bin.
RCRA HAZARDOUS Pharmaceutical Waste
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Presentation Notes
Hazardous Pharmaceutical Waste regulated by the Environmental Protection Agency (EPA) Any medications or container (IV bags, vials) that are delivered from pharmacy in a plastic zip top bag with a purple label on it must be placed back in the bag and sealed. Liquid from discontinued IV bags must be contained in another plastic bag before being discarded in the purple bin. No blood bags or sharps are to ever be disposed of in either of the bins. Blood bags are to be disposed of in the RED Biohazardous Waste bags. Sharps should only be disposed of in the sharps container. We do not want to pose the threat of a needle stick for the nurse to walk down the hall with a sharp. Even partially used pre-filled syringes such as Lovenox or Levemir flex-pens should be disposed of in the sharps container.
Why Are The Purple Dots Important?
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Discard In Purple Bin
Purple dots are placed only on the RCRA hazardous medications. This will alert nurses which medication will need to be disposed of in the purple bin when multiple medications are administered to the same patient. Any leftover or wasted medication should go into the purple labeled zip top plastic bag, sealed and then disposed of into the purple bin.
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Presentation Notes
Why Are the purple Dots Important? purple dots are placed only on the RCRA hazardous medications. This will alert nurses which medication will need to be disposed of in the purple bin when multiple medications are administered to the same patient. Any leftover or wasted medication should go into the purple labeled zip top plastic bag, sealed and disposed of into the purple bin.
What Goes In The White Bin?
• All other medications or containers (IV bags, vials gels, creams, ointments, paste, eye drops and ampoules) that are not classified as a “hazardous” pharmaceutical must be discarded in the white bin.
• Loose pills that are not eligible for return to
pharmacy. • NO SHARPS or BIOHAZARDOUS WASTE
are to be placed in the white bin. • These are considered non-hazardous or
“compatible” pharmaceuticals and can be co-mingled in the same bin.
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Presentation Notes
All other medications or containers (IV bags, vials, gels, creams, ointments, paste, eye drops and ampoules) that are not classified as a “hazardous” pharmaceutical must be discarded in the white bin. Loose pills that are not eligible for return to pharmacy. NO SHARPS or BIOHAZARDOUS WASTE are to be placed in the white bin. These are considered non-hazardous or “compatible” pharmaceuticals and can be co-mingled in the same bin. Ninety-five percent of your pharmaceutical waste will be disposed of in this bin.
What Goes In The 3 Gallon Black Jug?
All pressurized & ignitable aerosols from pharmacy must be disposed of in a smaller black jug as shown in the picture below.
What Goes in the 3 Gallon Black Jug? Another form of pharmaceutical waste are the aerosol medications. This waste stream must be separated from the other pharmaceutical waste in order to be safely incinerated and to comply with the Department of Transportations regulations. All used or opened aerosols must be disposed of into a 3 gallon black jug. These are NOT to go into the Return to Pharmacy bins which hold clean medication. This would cross contaminate all contents. All pressurized and ignitable pharmaceutical aerosols must be disposed of in a smaller black jug as shown in the picture below in order to comply with the Department of Transportation regulations. Some examples include Aerobid, Albuterol, Atrovent, Azmacort, Granulex, Dermaplast, Proctofoam, and Proventil.
Oncology Meds If you are working on an Oncology unit,
follow your unit’s guidelines.
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If you are working on an Oncology unit, follow your unit’s guidelines.
Location of Bins & Jugs
Please ask your nursing leadership to orient you on the location of the Pharmaceutical Waste bins and jugs on your unit.
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Presentation Notes
Please ask your nursing leadership to orient you on the location of the Pharmaceutical Waste bins and jug on your unit.
Wasting of Narcotics The procedure for any narcotics that are wasted
remains the same. The U.S. Drug Enforcement Administration (DEA) supersedes the EPA at this point in time.
Continue to follow your hospital policy on narcotics wasting procedure (double-witness wasting).
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Presentation Notes
Wasting of Narcotics The procedure for any narcotics that are wasted remains the same. The U.S. Drug Enforcement Administration (DEA) supersedes the EPA at this point in time. Continue to follow your hospital policy on narcotics wasting procedure (double-witness wasting).
Blood Bags & Sharps Blood bags and sharps MUST NOT go in the pharmaceutical
waste bins. Dispose of blood bags in RED BIOHAZARDOUS BAGS. Discard needles in sharps containers. Improper disposal of these items in Pharmaceutical Waste
bins will contaminate all contents, thereby creating a dangerous situation.
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Presentation Notes
Let’s review other waste streams such as blood bags and sharps disposal. Blood bags and sharps MUST NEVER go in the pharmaceutical waste bins. Also dispose of blood bags in RED BIOHAZARDOUS BAGS. And only dispose of needles in the sharps containers located inside each patient room. Improper disposal of these items in Pharmaceutical Waste bins will contaminate all contents, thereby creating a dangerous situation.
The cost to dispose of pharmaceutical waste in our average white bin when the appropriate medications are disposed of here is approximately $21. If a blood bag is improperly disposed of in one of our pharmaceutical waste bins, it drives up the cost to almost 7 times what it should have cost. Please make sure that you do not dispose of any blood bags in our pharmaceutical waste bins.
Label Information On Bins All bins must be labeled with a “Universal Pharmaceutical Waste”
tracking label. The label information is detailed with a container start/stop date, the phone number to call for pick up and delivery of bins and in the event of a spill, dial (#7777) to call a Code White.
Quick reference guide available on the Intranet.
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Presentation Notes
Both the purple and the white bins are to be labeled with a Universal Pharmaceutical Waste tracking label. The label information is detailed with a container start/stop date, the phone number to call for pick up and delivery of bins and in the event of a spill, dial (#7777) to call a Code White. There is also a quick reference guide available on the Intranet.
Internal Program Compliance Pharmaceutical Waste Disposal Task Forces have been created at each
entity to monitor compliance. This team consists of the Pharmacy Director, Pharmacy liaison, Safety Officer, Environmental Services Director, Nursing liaison and an Infection Control representative.
Random audits will be conducted on the nursing units, in the Pharmacy and in the Central Accumulation Area where the waste is stored before it is sorted and hauled.
Presenter
Presentation Notes
Pharmaceutical Waste Disposal Task Forces have been created at each entity to monitor compliance. This team will consist of the Pharmacy Director, Pharmacy liaison, Safety, Environmental Services Director, a Nursing liaison and an Infection Control representative. Random audits will be conducted on the nursing units, in the Pharmacy and in the Central Accumulation Area where the waste is stored before it is sorted and hauled. Scorecards will be reviewed monthly to keep the program on track.
External Program Survey
• The Florida Department of Environmental Protection is the regulatory agency that will come in unannounced to survey our practices. They have the authority to impose fines of $37,500 per violation/per day.
• This is a federally mandated program.
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Presentation Notes
The Florida Department of Environmental Protection is the regulatory agency that will come in unannounced to survey our practices. They have the authority to impose fines of $37,500 per violation/per day. Remember this program is federally mandated by the Environmental Protection Agency.
Questions?
If you have any questions about the program, please contact your Pharmacy Department.
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Presentation Notes
If you have any questions about the Pharmaceutical Waste Disposal Program, please contact your Pharmacy Department.
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