MEDICINES WASTE MANAGEMENT IN THE OXFORD RADCLIFFE HOSPITALS NHS TRUST

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MEDICINES WASTE MANAGEMENT IN THE OXFORD
RADCLIFFE HOSPITALS NHS TRUST

• Graham CrippsPharmacy Purchasing Distribution
  Operational Manager

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Overview of Oxford Radcliffe Hospitals NHS TRUST

• Approximately 1500beds
• Split over 3 sites
• Two in Oxford
• One in Banbury
• Annual drug spend 17m excl Homecare delivery
  medicines
• Provides wide range of general and specialist
  clinical services
• Emphasis on providing high quality healthcare and
  financial sustainability

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Pharmacy Service Provision

• Centralised Procurement from Pharmacy Purchasing
  and Distribution Unit (PPDU) at the Churchill
• Bedford Pharmacy Computer System used across all
  sites
• Site based dispensaries
• Consis Robot on the John Radcliffe site
• 28day or whole pack dispensing - one-stop
• Ward stock top-up service
• Ward based pharmacists technicians

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The Issues

• Internal problems
• Lack of clear process for returning medicines led
  to
• Large quantities of drugs brought back from wards
  and left in dispensaries
• Some medicines returned direct from wards to
  distribution unit
• Pharmacists trying to do their own returns on top
  of existing workload

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The Issues

• Lack of clear guidelines regarding what could be
  returned and what should be destroyed
• Fear that we were needlessly throwing away
  reusable medicines
• Low priority given to sorting returns
• Robotic dispensing
• Duplication of dispensing (drugs lost in
  system)
• Financial impact

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The Issues

• External factors
• Changes to EU Waste Management regulations
• Full pack dispensing/one-stop
• Prescribing decisions

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Solutions

• Raised profile of the importance of waste and
  returns management within pharmacy
• Centralised as much of the process to the PPDU
  (where feasible)
• Allocated protected time appropriate staff
  skill mix
• Developed clear and simple guidelines for returns
  destruction
• Ensured that these guidelines could be
  consistently followed

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Solutions

• Ensured appropriate double checks were made at
  each stage of the returns process to minimise
  risk
• Reduce the amount of returns generated
• Green medicine bags

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The triangular challenge

• THE WASTE TRIANGLE
• Our challenge is Avoidance.
• Requires greater input on managing medicines at
  ward level
• Requires buy in from wide group of stakeholders
  around the organisation
• Nursing / Auxiliary staff
• Doctors
• Patients

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Returns procedure see flow diagram

• Enables Distribution Assistants to make decisions
  regarding suitability of a drug to either be
  returned or destroyed
• Provides a step by step process to aid training
  new staff
• Two clear pathways
• Return
• Destruction waste procedure

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Returns pathway

• Every label generated above a nominal value at
  point of issue displays a _at__at_sign in top right
  corner
• Value has been set at 3.50
• Anything with the _at__at_ sign or full packs can be
  considered for return
• Any split pack not displaying this symbol may be
  considered as waste
• Current limitation applies only to patient
  specific dispensed medication

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Returns pathway - checking processes

• Stores whole pack returns
• All items returned into stores generate a Returns
  Note.
• Returns note used as a goods in note, and checked
  against items returned, by goods in staff,
  following standard goods in procedure.
• Every item returned is marked with red dot to
  comply with MHRA guidelines on resale of returned
  medicines.

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Returns pathway - checking processes

• Robot whole pack returns
• Once segregated - sent back to JR dispensary.
• Dispensary staff double check pack is complete.
• Scan barcode on label this simultaneously
  credits the stock back into the Robot and returns
  the label against the original issue on Pharmacy
  system, ensuring accurate stock and patient
  records are maintained.
• Split packs
• Assistant manually writes list of packs being
  sent back to the dispensary.
• Dispensary Technical staff use this list to
  either approve or reject return.
• If accepted item is returned into system and put
  back on shelf.

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Destruction pathway

• Drugs on the Indicative list of Cytotoxic and
  Cytostatic medicines display a !! on the label
  alerts staff of need to segregate
• All other medicines disposed of in yellow limb
  bins marked as Pharmacy Waste
• Segregating Cytotoxic waste reduces cost of
  destruction by 50

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Summary

• Centralised manageable process
• Consistent approach to returns / waste handling
• Allocated staff time approx 3-4hrs/day
• All new and existing Distribution staff trained
  in the processes and procedures
• Dispensary workload reduced as all returns are
  pre-sorted, further reduction to be achieved via
  bar code
• Green bag policy

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Summary

• Formation of Pharmacy Waste Management Group
• Aim to reduce waste as a top priority Avoidance
  the biggest challenge
• Includes representation from nursing staff
• Working with Trust Waste Manager to help wards
  manage waste medicines effectively
• Workload of managing the physical volume of
  returns is daunting and requires daily input
• Financial benefits
• Returns generated approx 300K per annum