Vanderbilt University Medical Center Pharmaceutical Waste Program USER INSERVICE

Transcription

1 Vanderbilt University Medical Center Pharmaceutical Waste Program USER INSERVICE

2 Training and Education Plan 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 inservices throughout the hospital March and March Stericycle will support continued compliance with follow up aftercare visits.

3 Why implement a Pharmaceutical Waste Program?

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

5 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.

6 What is Pharmaceutical Waste?

7 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

8 Pharmaceutical Waste Examples of pharmaceutical waste include opened / unused or partially used: Vials IV s and tubing Oral medications Ointments and Creams Note: Unopened medications are returned to the pharmacy.

9 Managing Pharmaceutical Waste

10 2 Basic Categories of Pharmaceutical Wastes EPA Regulated Pharmaceutical Wastes Non-EPA Regulated Pharmaceutical Wastes

11 EPA Regulated Pharmaceutical Waste Using the EPA regulations, Stericycle and VUMC have classified these pharmaceuticals under 4 codes to help with proper disposal: B Toxic/ Flammable P Acutely Toxic A Aerosols/ Inhalers V Miscellaneous

12 Identifying EPA Regulated Pharmaceutical Wastes 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

13 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.

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

15 The EPA Regulated Pharmaceutical Waste List is available on edocs List is available on edocs and is posted in medication supply and storage areas.

16 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) Non-Regulated Your work area may not need all containers shown.

17 Disposal of P and B Coded Pharmaceutical Wastes P Acutely Toxic B 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. Seal free liquids in a zip lock bag

18 Disposal of A Coded Pharmaceutical Wastes A Aerosols/ Inhalers A coded Pharmaceutical Wastes are placed in the clearly identified BLACK container with the GREEN Label. Separate container is required since aerosols are considered hazardous during transport. Examples: Asthma inhalers, Cetacaine spray

19 Disposal of V Coded Pharmaceutical Wastes V Miscellaneous 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 ( ) for pick-up V coded Wastes are managed by Vanderbilt Environmental Health and Safety

20 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

21 These wastes will NOT be disposed in the new RX waste containers Waste containing blood or other body fluids; waste from isolation rooms Sharps discard in sharps containers Chemo Waste 95% Controlled Substances Follow VUMC policy CL

22 These wastes will NOT be disposed in the new RX waste containers Plain down the drain Plain IVs Can still go down the drain. Examples include: Saline, Potassium, D5, Electrolytes, and Lactated Ringers. (No Medications Instilled) 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.

23 How are the Pharmaceutical Waste containers managed?

24 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.

25 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.

26 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 (VUH) (VCH) (SMS/Clinics) All Rx waste is packaged, labeled, manifested, and shipped in compliance with DOT regulations to end disposal facilities.

27 REVIEW OF PROPER DISPOSAL PRACTICES FOR PHARMACEUTICAL WASTES

28 Narcotics Disposal No Change to Procedures Waste Partial Doses DEA controlled substances Witnessed Disposal per policy CL Controlled Substance Administration & Accountability Empty syringe & needle to sharps container. Empty amp or vial to sharps container.

29 Chemotherapeutic Medication Disposal No Change to Procedures Chemotherapy medications are identified with a Y code on the label. 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.

30 Disposal of Unused Pharmaceutical Waste DISPOSAL CODES Message or Code NO ALERT A B P V Action Dispose in Blue Container Dispose in Black Container with GREEN Label Dispose in Black Container Dispose in Black Container (Include the packaging) Seal in a ziploc bag and call VEHS for pick up.

31 Disposal of Unused Pharmaceutical Waste Dispose of Controlled Substances, Sharps, Chemo waste, and Plain IVs per hospital policy Non-regulated Pharmaceutical Waste (No Acudose/EMAR Alert) No Code This will include about 95% of the wasted pharmaceuticals. Seal free liquids in a zip lock bag

32 Disposal of Unused Pharmaceutical Waste EPA Regulated Pharmaceutical Waste (Alerts) A Aerosols/ Inhalers B Toxic/ Flammable P Acutely Toxic V Miscellaneous B Unused meds P Unused meds & Empty packaging SEAL IN BAG Seal free liquids in a zip lock bag Call VEHS for Pickup

33 For additional questions about the Pharmaceutical Waste Program Contact Vanderbilt Environmental Health and Safety (VEHS): Phone: