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Exploring safer methods for managing pharmaceutical waste
Exploring safer methods for managing pharmaceutical waste Nurses are collaborating with pharmacists, waste companies and other experts to find safer ways for disposing of pharmaceutical waste
By Carina Stanton Senior News Editor hen a surgical case ends, a perioperative nurse is often responsible for disposing of any unused pharmaceuticals left on the surgical field, such as an excess amount of heparin or epinephrine. The method for this disposal has long been to flush non-hazardous pharmaceutical waste down the drain to divert the medications from being misused under the assumption that waste water treatment plants remove the drugs before discharge to surface wasters. However, there is growing concern among community leaders that trace amounts of these wasted medications are remaining in the community water supply.
W
Raising the issue Some community leaders are beginning to take a closer look at pharmaceutical waste. Proactive efforts, such as local and federal drug takeback days, are being held to divert consumer medications from being flushed down the drain. Health care facilities also are being more heavily scrutinized about pharmaceutical waste practices. Last year five health care facilities in New York were involved in settlements with the New York Attorney General for their practice of dumping certain pharmaceuticals into New York City watersheds. Under the settlement agreements the facilities were fined and required to begin sending all pharmaceutical waste to a designated pharmaceutical waste disposal site, according to doi: 10.1016/S0001-2092(11)00953-7
© AORN, Inc, 2011
Health care professionals who flush unused pharmaceuticals down the drain may want to think twice about the long term effects of this common method for disposal.
a Jan. 12, 2010 media release from the New York Attorney General. Health care leaders are discussing new ways to protect the community from pharmaceutical waste. “A truly sustainable drug disposal system is needed that prevents drugs, waste drug emissions, and other drug waste from entering our water, air and soil and that renders drug waste harmless,” said Karen A. Daley, PhD, MPH, RN, FAAN, president of the American Nurses Association (ANA). In Dec. 2010, ANA adopted policy that articulates ANA’s position on the role of the registered nurse in addressing pharmaceutical waste generation and disposal. PHARM Continued on C8 October 2011 Vol 94 No 4 • AORN Connections | C1
pharm Continued from C1
“Proper pharmaceutical disposal is critical for nurses since they directly dispose and supervise others’ disposal of pharmaceutical waste,” Daley noted. She said “nurses also educate patients, nursing students, certified medication aides and other members of the community on proper pharmaceutical waste disposal.” The perioperative nurse’s role in addressing pharmaceutical waste reduction and disposal can occur at several points throughout a patient’s care, whether a perioperative nurse is reviewing a patient’s medications during preoperative assessment, managing a patient’s medications during surgery or providing medication instructions prior to discharging a patient, explained Bonnie Denholm, MS, RN, CNOR, an AORN perioperative nursing specialist and lead author of a new set of AORN Medication Safety recommended practices that will soon be released. Within the recommendations, perioperative nurses are encouraged to collaborate with pharmacists and other colleagues involved in managing the process for safe disposal of pharmaceutical waste, Denholm noted. She stressed the importance of open communication between perioperative nurses and pharmacists in addressing pharmaceutical waste and other aspects of medication safety. “These collaborations are often established and strengthened through the work of health care facility “green” teams where safe disposal of pharmaceutical waste is discussed as part of broader efforts to reduce health care generated waste that can negatively impact the environment,” she added.
Prescription Drug Take Back Day is Oct. 29 The U.S. Drug Enforcement Administration has scheduled a Prescription Drug Take Back Day on Oct. 29, 2011, to provide a venue for any individuals and long term care facilities who wish to dispose of unwanted and unused prescription drugs. ANA and AORN both support participation in this event. To learn more about local collection locations in your area visit www.deadiversion.usdoj.gov/drug_disposal/ takeback.
C8 | AORN Connections
Making a change Members of the Nursing Practice Congress at the University of Alabama (UAB) Medical Center in Birmingham, Al., are addressing pharmaceutical waste as part of an organization-wide effort to promote environmentally-friendly and financially sustainable practices. “Our organization is re-evaluating the entire workflow around wasting medications and how it is affecting the environment,” explained Kristen Noles, RN-BC, advanced nursing coordinator, Center for Nursing Excellence at UAB Medical Center. “The health care community is becoming more aware of our environmental impact, but more attention needs to be focused on pharmaceutical waste,” she stressed. Noles encouraged nurses to stop and think about how they are wasting pharmaceuticals and talk to colleagues within and outside their area to think through possible ways for making the pharmaceutical wasting process safer for all, now and in the future. Should do vs. must do Regulatory agencies are taking a closer look at pharmaceutical waste and facilities that are now working to address the issue will be ahead of the game if stricter state and federal requirements for pharmaceutical waste disposal are implemented, according to Charlotte Smith, RPh, MS, director of Pharmaceutical Services for WM Healthcare Solutions, Inc., a Waste Management Company. Smith began her work in the field of pharmaceutical waste more than 20 years ago and launched her own pharmaceutical waste consulting company, PharmEcology Associates, LLC before selling the assets of the company to WM Healthcare Solutions, Inc. and continuing to direct operations of the program. Through the program, consultants work with a health care facility to review and categorize the pharmaceutical inventory with respect to disposal requirements, make plans to properly manage the waste when a pharmaceutical product is discarded, and educate staff members about their role in this process. In 2006, Smith also helped create a 10-step blueprint for managing pharmaceutical waste in health care facilities in the U.S., which was revised in 2008 and is part of Practice Greenhealth’s resources. “Although nurses working in the perioperative setting and other areas of a health care facility
Summary of Recommended Pharmaceutical Waste Streams* Compatible Hazardous Waste*
Aerosols
Trace Chemo (Sharps)
Trace Chemo (Soft)
Non Hazardous Drugs
Municipal Solid Waste
Red Sharps
Sewer System
* Dual waste for sharps • P-listed (inc. containers) • U-listed • D-listed t toxic, • Ignitable • Bulk chemo • Haz/Chemo spill clean up • PharmE Haz®
• Ignitable aerosols • Pressurized aerosols
• Empty vials and ampules • Empty syringes and needles • Empty IVs
Federally Permitted Hazardous Waste Incinerator
Ash
Lined Hazardous Waste Landfill
*May vary based on individual facility needs.
• Gowns • Gloves • Tubing • Wipes • Packaging
• All non-hazardous pharmaceutical waste • No biohazardous drugs
• Most packaging • Most empty bottles and vials • Most empty IVs • Paper • Plastic • No drugs • No P-waste containers
Autoclave/ Microwave
Medical Waste Incinerator
Ash
• Empty syringes, needles, ampules (except chemo) • Bio-hazardous drugs
Ash
• IVs o Dextrose o Saline o Sterile Water o Lactated Ringer’s o K salts o Ca salts o Mg salts • Controlled substances • No other drugs
Publicly Owned Treatment Works ( POTW)
Shredded (Most states)
Lined Non-Hazardous Waste Landfill
Water Supply
Copyright 2011 WM Healthcare Solutions, Inc
This information is solely for educational purposes and provides only a general description of various regulatory requirements. For a complete description, please consult the relevant federal and state regulatory statutes. Nothing in this information constitutes legal advice and you should not legally rely on any information provided in this presentation. We make no warranty, express or implied, with respect to such information and disclaim all liability resulting from any use or reliance of this information.
Pharmaceutical waste follows different paths for disposal based on regulatory requirements and a health care facility’s established process for safe disposal of unused pharmaceuticals. Source: WM Healthcare Solutions, Inc. Used with permission
are not often involved in managing the flow of pharmaceutical waste beyond their practice setting,” Smith said. She explained the critical role nurses play in the process, noting several of the key issues for pharmaceutical waste that nurses need to be aware of, including: • Federal and state regulatory requirements for safe disposal of pharmaceutical waste, including definitions for safe disposal of hazardous and non-hazardous pharmaceutical waste. • The entire disposal process of pharmaceuticals, from “cradle to grave” (creation to destruction) and the role a perioperative nurse plays in this process. • Potential impacts of pharmaceutical waste on the environment. Although all health care facilities are required under the federal Resource Conservation and Recovery Act (RCRA) to follow a specific © AORN, Inc, 2011
process for discarding medications that meet the definitions of a hazardous waste, (the “mustdo’s”), such as a number of chemotherapy drugs, the federal and state requirements are not as clear for disposing of drugs that are not classified as hazardous waste under this old law, which was passed in 1976 (the “should do’s”). “With attention to this issue coming out of the Government Accountability Office and Congress, I don’t think it is a concern that is going away. If you don’t do what you should do it’s likely to turn into must do,” she noted.
Join the conversation Visit the “Going Green in the OR” discussion forum on ORNurseLink to share information and success stories about green initiatives in the OR, including safe disposal of pharmaceutical waste. www.ornurselink.org
October 2011 Vol 94 No 4 • AORN Connections | C9
By Carina Stanton Senior News Editor hen a surgical case ends, a perioperative nurse is often responsible for disposing of any unused pharmaceuticals left on the surgical field, such as an excess amount of heparin or epinephrine. The method for this disposal has long been to flush non-hazardous pharmaceutical waste down the drain to divert the medications from being misused under the assumption that waste water treatment plants remove the drugs before discharge to surface wasters. However, there is growing concern among community leaders that trace amounts of these wasted medications are remaining in the community water supply.
W
Raising the issue Some community leaders are beginning to take a closer look at pharmaceutical waste. Proactive efforts, such as local and federal drug takeback days, are being held to divert consumer medications from being flushed down the drain. Health care facilities also are being more heavily scrutinized about pharmaceutical waste practices. Last year five health care facilities in New York were involved in settlements with the New York Attorney General for their practice of dumping certain pharmaceuticals into New York City watersheds. Under the settlement agreements the facilities were fined and required to begin sending all pharmaceutical waste to a designated pharmaceutical waste disposal site, according to doi: 10.1016/S0001-2092(11)00953-7
© AORN, Inc, 2011
Health care professionals who flush unused pharmaceuticals down the drain may want to think twice about the long term effects of this common method for disposal.
a Jan. 12, 2010 media release from the New York Attorney General. Health care leaders are discussing new ways to protect the community from pharmaceutical waste. “A truly sustainable drug disposal system is needed that prevents drugs, waste drug emissions, and other drug waste from entering our water, air and soil and that renders drug waste harmless,” said Karen A. Daley, PhD, MPH, RN, FAAN, president of the American Nurses Association (ANA). In Dec. 2010, ANA adopted policy that articulates ANA’s position on the role of the registered nurse in addressing pharmaceutical waste generation and disposal. PHARM Continued on C8 October 2011 Vol 94 No 4 • AORN Connections | C1
pharm Continued from C1
“Proper pharmaceutical disposal is critical for nurses since they directly dispose and supervise others’ disposal of pharmaceutical waste,” Daley noted. She said “nurses also educate patients, nursing students, certified medication aides and other members of the community on proper pharmaceutical waste disposal.” The perioperative nurse’s role in addressing pharmaceutical waste reduction and disposal can occur at several points throughout a patient’s care, whether a perioperative nurse is reviewing a patient’s medications during preoperative assessment, managing a patient’s medications during surgery or providing medication instructions prior to discharging a patient, explained Bonnie Denholm, MS, RN, CNOR, an AORN perioperative nursing specialist and lead author of a new set of AORN Medication Safety recommended practices that will soon be released. Within the recommendations, perioperative nurses are encouraged to collaborate with pharmacists and other colleagues involved in managing the process for safe disposal of pharmaceutical waste, Denholm noted. She stressed the importance of open communication between perioperative nurses and pharmacists in addressing pharmaceutical waste and other aspects of medication safety. “These collaborations are often established and strengthened through the work of health care facility “green” teams where safe disposal of pharmaceutical waste is discussed as part of broader efforts to reduce health care generated waste that can negatively impact the environment,” she added.
Prescription Drug Take Back Day is Oct. 29 The U.S. Drug Enforcement Administration has scheduled a Prescription Drug Take Back Day on Oct. 29, 2011, to provide a venue for any individuals and long term care facilities who wish to dispose of unwanted and unused prescription drugs. ANA and AORN both support participation in this event. To learn more about local collection locations in your area visit www.deadiversion.usdoj.gov/drug_disposal/ takeback.
C8 | AORN Connections
Making a change Members of the Nursing Practice Congress at the University of Alabama (UAB) Medical Center in Birmingham, Al., are addressing pharmaceutical waste as part of an organization-wide effort to promote environmentally-friendly and financially sustainable practices. “Our organization is re-evaluating the entire workflow around wasting medications and how it is affecting the environment,” explained Kristen Noles, RN-BC, advanced nursing coordinator, Center for Nursing Excellence at UAB Medical Center. “The health care community is becoming more aware of our environmental impact, but more attention needs to be focused on pharmaceutical waste,” she stressed. Noles encouraged nurses to stop and think about how they are wasting pharmaceuticals and talk to colleagues within and outside their area to think through possible ways for making the pharmaceutical wasting process safer for all, now and in the future. Should do vs. must do Regulatory agencies are taking a closer look at pharmaceutical waste and facilities that are now working to address the issue will be ahead of the game if stricter state and federal requirements for pharmaceutical waste disposal are implemented, according to Charlotte Smith, RPh, MS, director of Pharmaceutical Services for WM Healthcare Solutions, Inc., a Waste Management Company. Smith began her work in the field of pharmaceutical waste more than 20 years ago and launched her own pharmaceutical waste consulting company, PharmEcology Associates, LLC before selling the assets of the company to WM Healthcare Solutions, Inc. and continuing to direct operations of the program. Through the program, consultants work with a health care facility to review and categorize the pharmaceutical inventory with respect to disposal requirements, make plans to properly manage the waste when a pharmaceutical product is discarded, and educate staff members about their role in this process. In 2006, Smith also helped create a 10-step blueprint for managing pharmaceutical waste in health care facilities in the U.S., which was revised in 2008 and is part of Practice Greenhealth’s resources. “Although nurses working in the perioperative setting and other areas of a health care facility
Summary of Recommended Pharmaceutical Waste Streams* Compatible Hazardous Waste*
Aerosols
Trace Chemo (Sharps)
Trace Chemo (Soft)
Non Hazardous Drugs
Municipal Solid Waste
Red Sharps
Sewer System
* Dual waste for sharps • P-listed (inc. containers) • U-listed • D-listed t toxic, • Ignitable • Bulk chemo • Haz/Chemo spill clean up • PharmE Haz®
• Ignitable aerosols • Pressurized aerosols
• Empty vials and ampules • Empty syringes and needles • Empty IVs
Federally Permitted Hazardous Waste Incinerator
Ash
Lined Hazardous Waste Landfill
*May vary based on individual facility needs.
• Gowns • Gloves • Tubing • Wipes • Packaging
• All non-hazardous pharmaceutical waste • No biohazardous drugs
• Most packaging • Most empty bottles and vials • Most empty IVs • Paper • Plastic • No drugs • No P-waste containers
Autoclave/ Microwave
Medical Waste Incinerator
Ash
• Empty syringes, needles, ampules (except chemo) • Bio-hazardous drugs
Ash
• IVs o Dextrose o Saline o Sterile Water o Lactated Ringer’s o K salts o Ca salts o Mg salts • Controlled substances • No other drugs
Publicly Owned Treatment Works ( POTW)
Shredded (Most states)
Lined Non-Hazardous Waste Landfill
Water Supply
Copyright 2011 WM Healthcare Solutions, Inc
This information is solely for educational purposes and provides only a general description of various regulatory requirements. For a complete description, please consult the relevant federal and state regulatory statutes. Nothing in this information constitutes legal advice and you should not legally rely on any information provided in this presentation. We make no warranty, express or implied, with respect to such information and disclaim all liability resulting from any use or reliance of this information.
Pharmaceutical waste follows different paths for disposal based on regulatory requirements and a health care facility’s established process for safe disposal of unused pharmaceuticals. Source: WM Healthcare Solutions, Inc. Used with permission
are not often involved in managing the flow of pharmaceutical waste beyond their practice setting,” Smith said. She explained the critical role nurses play in the process, noting several of the key issues for pharmaceutical waste that nurses need to be aware of, including: • Federal and state regulatory requirements for safe disposal of pharmaceutical waste, including definitions for safe disposal of hazardous and non-hazardous pharmaceutical waste. • The entire disposal process of pharmaceuticals, from “cradle to grave” (creation to destruction) and the role a perioperative nurse plays in this process. • Potential impacts of pharmaceutical waste on the environment. Although all health care facilities are required under the federal Resource Conservation and Recovery Act (RCRA) to follow a specific © AORN, Inc, 2011
process for discarding medications that meet the definitions of a hazardous waste, (the “mustdo’s”), such as a number of chemotherapy drugs, the federal and state requirements are not as clear for disposing of drugs that are not classified as hazardous waste under this old law, which was passed in 1976 (the “should do’s”). “With attention to this issue coming out of the Government Accountability Office and Congress, I don’t think it is a concern that is going away. If you don’t do what you should do it’s likely to turn into must do,” she noted.
Join the conversation Visit the “Going Green in the OR” discussion forum on ORNurseLink to share information and success stories about green initiatives in the OR, including safe disposal of pharmaceutical waste. www.ornurselink.org
October 2011 Vol 94 No 4 • AORN Connections | C9