University of Pennsylvania

1
RxPunge Pharmaceutical Waste Disposal System for
HUP
University of Pennsylvania Department
of Electrical and Systems Engineering
Authors Thalia Shamash ESE 09 Daniel Hillman
ESE 09 Ethan Keller ESE 09 Emily McGrath ESE
09 GROUP 14 Advisor Dr. John Keenan
Data Collection Two separate studies were
conducted in which wasted medications were
meticulously documented I RxPunge driven study
11/21/08 12/14/08 Over 1,400 IV bags were
processed twice a day. Analysis focused on drug
type, IV volume, and quantity of active drug.
Data assisted with formulation of drug categories
and helping guide disposal and treatment
research. II HUP driven study 2/24/09
3/16/09 Over 1100 IV bags were recorded. Data
contributed to understanding of IV preparation
times, expiration dates, and cost
structure. After the data collection, RxPunge
categorized the drugs into over 40 categories.
Five of the most abundant categories were chosen
for analysis because of their large numbers and
adverse impacts. These were antibiotics,
hormones, vasoactive drugs, anti-seizure drugs,
and antiviral drugs.
Background In thousands of medical facilities
and millions of homes throughout the country,
medications are consumed on a daily basis.
Hospitals generate large quantities of medical
waste, including biohazard, sharps, and others,
which are regulated and disposed of safely. A
large gap exists with regard to pharmaceutical
waste that has not been explicitly designated as
hazardous. This waste has been shown to cause
harmful effects on natural ecosystems.
Furthermore, recent research has indicated that
such medications are present in natural and
municipal water sources. In fact, researchers
with the U.S. Geological Survey have reported the
presence of various antibiotics just downstream
of hospital and municipal wastewater treatment
plants in a number of states.
Drug Distributions
Vasoactive Drugs
Antiseizure Drugs
Antiviral Drugs
Drugs in the Environment

• Data Findings
• 44 of the drugs recorded were antibiotics
• Top 5 categories of interest represent 67 of
  total drugs recorded
• 4 of containers collected are hazardous
  according to OSHA
• Highest drug waste occurs on weekends
• Critical Care units have the largest amount of
  waste
• Ten drugs account for 68 of waste costs
• 70 of these drugs on average are administered to
  a patient more than once a day
• 50 have expiration dates longer than a day

Antibiotics
Hormones

• Increase propagation of antibiotics-resistant
  bacteria strains
• Kill off healthy ecosystem bacteria and microbial
  algaes

Abstract There is a growing concern in the
medical and environmental communities regarding
the current disposal methods for pharmaceutical
waste. The practice of discarding expired pills
and intravenous solutions in sink drains of
hospitals compromises the safety of our water and
environment. RxPunge has worked closely with the
inpatient pharmacy at the Hospital of the
University of Pennsylvania (HUP) to study the IV
waste system in place and to assist the pharmacy
in pioneering a new system to properly classify,
manage, and dispose of these dangerous chemicals.
RxPunge recorded quantities and types of expired
IV drug solutions returned to the pharmacy to
assess the current system in place. Over 150
drugs were classified and evaluated for hazard,
reactivity, biodegradation, and potential
disposal methods. Statistical distributions were
identified to simulate the drug disposal, and
these were used to develop a stochastic
simulation to predict the daily mix of
pharmaceutical waste. This model, combined with
implementable recommendations, depicts a method
to better manage pharmacy operations and reduce
hazardous waste. Inventory practices,
drug-preparation times and distribution
frequencies can be modified to reduce drug waste
from the hospital and cut costs. Waste disposal
and treatment methods were analyzed, thereby
providing actionable options with which HUP
create positive environmental impact.
Disposal and Treatment A thorough review of
Material Safety Data Sheets (MSDS) was conducted
in order to evaluate drug toxicity. Drugs were
rated based on flammability, solubility,
environmental hazard and toxicity. These
parameters determine how expired drugs will be
collected in containers, mixed with other waste,
and transported. Waste disposal and treatment
methods were analyzed, providing actionable
options with which HUP can mitigate its
environmental impact. Based on consultations and
research, the most practical and cost-efficient
method of disposal is incineration. Potential
incineration sites in the Philadelphia area were
identified, with costs, shipping distances and
safety features considered. The RxPunge model
was used to simulate expected waste volumes and
then was employed to determine collection
frequency and receptacle size.

• Disturb endocrine systems, impair, and adversely
  effect biological characteristics of humans and
  wildlife (e.g. feminized fish)

Collaboration RxPunge conducted a careful review
of regional hospitals, ultimately choosing the
Hospital of the University of Pennsylvania (HUP)
as the most appropriate partner. Reasoning
included HUPs stature as a cutting edge hospital
which pioneers industry standards in addition to
the willingness of key management to partners
with Penn Engineering students. Planning meetings
with hospital management helped identify
Intravenous (IV) waste as the primary subject for
analysis. RxPunge has since developed a close
relationship with directors of the Inpatient
Pharmacy and has conducted bi-weekly meetings on
site. The first stage in RxPunges analysis was
to examine the current process within HUP (as
depicted in blue in the chart below). Key
decision nodes affecting waste output were
identified (orange) as main components of a
potential RxPunge solution. The Inpatient
Pharmacy serves as a hub for storage, dispatch,
and sorting of pharmaceutical inventory.
Medication solutions are mixed and sent out to
the floors. Drugs not administered to patients
are returned to the pharmacy during pick up
rounds that occur twice a day. Upon return,
unexpired drugs are recycled, and expired
medicines are poured into an industrial sink in
the IV processing room.

• Recommendations
• RxPunge Inventory Solution
• Incorporating additional drug deliveries runs
  within HUP
• Elimination of bulk preparation for uncommon
  drugs
• Same day preparation to extend expiry time
• Better enforcement of FIFO inventory management
• RxPunge Disposal Solution
• Collection and categorization of expired drugs
• Transportation to and incineration in 1 of 3
  identified waste management sites
• Collection of waste from outside management once
  per month
• While currently infeasible, sewage treatment will
  provide a more comprehensive solution in the
  future.

The RxPunge Model This model depicts the current
pharmacy waste output. Using the collected data
and sophisticated statistical software, disposal
distributions were backed-out to represent
medication categories that were returned to the
pharmacy. Random variables were generated
according to these distributions. Assumptions
were made based on interviews with pharmacy
personnel. These data were used to simulate
expected dispatch, returns, and waste of various
drug categories on a given day.
DEMO TIMES Thursday, April 23rd 2009 AM 900,
930, 1000 PM 300
Block diagram of process stages and locations for
drug disbursement in HUP Blue Existing
Process Orange Proposed Modifications
Assumptions drugs that go out a day are
returned N(30, 2.5) drugs that are returned
are expired N(30, 5)