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Exeter Hospital Pharmaceutical Waste Management Program

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Exeter Hospital Pharmaceutical Waste Management Program Deanna King RPh, MS Director of Pharmacy Tamara Harmer Environment of Care Specialist December 2, 2010 – PowerPoint PPT presentation

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Title: Exeter Hospital Pharmaceutical Waste Management Program


1
Exeter Hospital Pharmaceutical Waste Management
Program
  • Deanna King RPh, MS
  • Director of Pharmacy
  • Tamara Harmer
  • Environment of Care Specialist
  • December 2, 2010

2
Why We Implemented a Program
  • Compliance
  • Cost Savings
  • Recognition
  • Certification

3
Compliance
  • US Environmental Protection Agency (EPA)
  • New Hampshire Department of Environmental
    Services (NHDES)
  • The Joint Commission
  • Occupational Safety and Health Administration
    (OSHA)
  • Department of Transportation (DOT)

4
Cost Savings
  • Evaluation of Current Practices revealed
    opportunity to reduce the amount of waste going
    out as hazardous

5
Recognition
  • Industry leader
  • Environmental Best Practices
  • Align with hospital Going Green initiative to
    reduce and recycle waste

6
Certification
  • Compliance of customized policies
  • Implementation validation
  • Third Party confirmation to EPA DES
  • Press release assistance

7
Steps Toward Implementation
  • Step 1 Get Commitment
  • Step 2 Inventory Analysis
  • Step 3 Choose a System
  • Step 4 Pilot Programs
  • Step 5 House wide Roll-out
  • Step 6 Do it again!!

8
Step 1 Get Commitment
  • Senior Leadership
  • EOC Committee

9
Building our Team
  • Environmental Services
  • Pharmacy
  • Safety
  • Nursing
  • Infection Control
  • Facility Management
  • Risk Management
  • Purchasing
  • Storeroom
  • Security

10
Team Responsibilities
  • Understand Regulatory Requirements
  • Determine where Pharmaceutical Waste is generated
    and discarded
  • Develop an Action Plan
  • Choosing our consultant
  • Stericycle
  • PharmEcology
  • Triumverate

11
Step 2 Inventory Analysis
  • Listed Waste
  • P-Listed
  • U-Listed
  • Characteristic Waste
  • Ignitable, Corrosive, Reactive, Toxic

12
Inventory Analysis Continued
  • Compatable v. Non compatable
  • Reactive ie silver nitrate sticks
  • Trace v. bulk Chemo waste
  • PharmE Hazardous Waste

13
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14
Step 3 Choose a Management System
  • I. Collect and dispose 100 as hazardous waste
  • II. Collect 100 as hazardous waste with on-site
    sorting before disposal
  • III. Sort at point of waste generation

15
Where are the points of generation?
  • Pharmacy Department
  • Inpatient Care Units
  • Emergency Department
  • Surgical Suites inpatient/outpatient
  • Oncology
  • Diagnostic Imaging
  • Storeroom

16
Evaluate Current Practices
  • On-Site Risk Assessment
  • Key Staff interviews
  • Frequency and volume of use
  • Container labeling practices
  • Space configuration
  • Staff training programs

17
Individual product identification
  • Pharmacy Shelves
  • eMAR
  • Pyxis
  • Product packaging
  • Still in process

18
Meet with Waste Vendors
  • Met with each vendor to identify their transport
    licensure for hazardous waste
  • Cost Estimates for waste removal
  • Determine generator status

19
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20
The System We Chose
  • Sort at Point of Generation
  • Lower cost than 100 hazardous waste
  • Lower exposure risk than single stream collection
    with in-house sorting

21
Step 4 Pilot Programs
  • Most complex area Med Oncology
  • Highest volume Med Oncology
  • Consistent staffing/operating hours
    Medical Oncology

22
Drug Name Full/Partial Disposal Empty Disposal Drug Name Full/Partial Disposal Empty Disposal
Alteplase/Cathflo White Solid Aprepitant /Emend PO IV White Solid
Atropine White Solid Calcium Gluconate Drain Solid
Ceftazidime/Fortaz White Solid Ceftriazone/Rocephin White Solid
Darbepoetin/Aranesp Prefilled syringes White Red Darbepoetin/Aranesp Vials Only Red Red
Deferoxamine/Desferal Black Solid Desmopressin/DDAVP White Solid
Dexamethasone White Solid
Enoxaparin/Lovenox White Red-syringe Epinephrine White Solid
Epoetin/Epogen/Procrit White Solid
Ferrlecit White Solid Fondaparinux/Arixtra White Solid Syringe- red
Fulvestrant/Faslodex Black Yellow Furosemide White solid
Gammagard Red Red Goserelin/Zoladex Black Yellow
Hydrocortisone White Solid

23
Oncology Pilot
  • Initial Meeting (Eye Opening)
  • Identified issues with utilization of waste
    streams
  • Over utilization of black containers
  • Underutilization of red containers
  • Misuse of yellow containers
  • Gowning practices
  • Policies and Procedures

24
Culture Change
  • Hazardous and Spills (Black)
  • Trace containers (Yellow)
  • Hampers (Yellow)
  • Profile Non-antineoplastics
  • Non-hazardous waste (White)
  • Infectious (Red)

25
Supplies
  • Purchasing/Storeroom
  • Establish a contact person
  • Set a supply deadline
  • Containers
  • Configuration/size/vendor
  • Notify reduction of black boxes needed
  • Hampers
  • Bags/labeling/hamper

26
Pharmaceutical Waste Streams
DRAFT
Is it an Empty Med Container or Needle?
No
Yes
Hazardous P/U/D-listed, Chemo, Aerosols
or Endocrine Disruptors
It is a Needle
Had a P-Listed Med in it or is an Aerosol
All other Containers
Non-Hazardous
Controlled Drugs Fentanyl Patch
Trash Can
Red Sharps Box
Black Container
Black Container
White with Blue lid
Sewer
01/28/2010
27
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28
Definition of Empty
  • All material that can be removed by normal means
  • Less than 3 percent by weight of the total
    container capacity
  • Exception P-listed acute hazardous waste

29
Environmental Services
  • Hazardous Waste Handler Training
  • Limited staff selected
  • Container color scheme
  • Introduction of Hampers
  • Black container requirements
  • Segregation within Haz Waste storage room

30
Security
  • Spill Response Team
  • Spill kit use and location
  • Container Color Scheme
  • Pepper Spray

31
Step 5 House wide Roll-out
  • Weekly Meetings
  • Meet with Dept Directors/Managers
  • Attend staff meetings
  • Update Policies and Pharmacy Website
  • Create quick reference guide
  • Use corporate newsletter and intranet to announce
    roll-out
  • Scheduled Follow-up Sessions

32
Dept Director/Manager Meetings
  • Prior to meeting we prepared department specific
    medication profile based on pyxis med summary
    report
  • Presented overview of program
  • Confirmed medication profiles and department
    waste charts
  • Set roll out date

33
Staff Meetings
  • Program overview
  • Department Waste Chart
  • Container colors and locations
  • Black Box requirements
  • Quick Reference List

34
Pharmaceutical Waste Management Quick Reference
List
  • All sugars, salts and electrolytes can go down
    the drain
  • Example D5W, NS, with or w/o Potassium, Bicarb
    Drips, dialysate, mannitol
  • Narcotics Follow Current Policies
  • Example witness waste through Pyxis
  • Chemotherapeutic Agents
  • Example unused or bulk (greater than 3 volume)
    is returned to Pharmacy
  • Trace or empty go in yellow trace chemo bin

35
Pharmaceutical Waste Management Quick Reference
List
  • Hazardous (P-Listed) Medications
  • Example Warfarin, Nicotine, Physostigmine
  • these medications as well as the wrappers
  • Must be disposed of in the Black Bin
  • Pharmaceutical Hazardous Medications
  • Example refer to your department specific
    profile
  • If its empty, landfill is OK

36
Follow-up Sessions
  • Program Monitoring
  • Container usage
  • Quiz staff
  • QA
  • Committee Meetings
  • Select Champions
  • Feedback to Director/Managers

37
Regulatory Compliance
  • Hospital Specific Categorization
  • Pharmacy Website
  • Committee minutes
  • Training sign in sheets
  • Annual Coordinator training

38
Step 6 Do it all over again
  • New product assessments
  • Pharmacy Therapeutics Committee
  • Department Profile/Chart updates
  • Refresher training
  • Obtain Maintain Certification

39
Our Conclusions
  • Clearly define your goals
  • Take it one step at a time
  • Involve everyone
  • Be prepared to educate, educate, educate
  • Breathe

40
Resources
  • http//www.cleanharbors.com/browse_by_industry/hea
    lthcare/
  • http//des.nh.gov/organization/divisions/water/dwg
    b/dwspp/medsafety/index.htm
  • http//www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.h
    tml
  • http//www.pharmecology.com/pedd/jsp/index.jsp
  • http//www.epa.gov/waste/hazard/index.htm
  • http//cms.h2e-online.org/

41
Thank you!
  • Deanna King dking_at_ehr.org
  • Tamara Harmer tharmer_at_ehr.org
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