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Pharmaceutical Waste Management
Darlene Smith, Medication Safety Pharmacist, Wimmera Health Care Group
and
Rachel McConville, Waste Education Officer, DHHS
July 2019
Acknowledgements
• Bernie Squires, Business Manager – Sales, Daniels Health
• Brennan Fitzpatrick, Clinical Pharmacist – Perioperative Services, Royal Melbourne Hospital
• Bishma Jayathilaka, Clinical Pharmacist/Medication Safety, Peter MacCallum Cancer Centre
• Danielle Venter, National Sales Manager, Drug Waste Bins International
• Galahad Gu, Senior Operating Theatre and Peri-operative Medicines Pharmacist, Eastern Health
https://theconversation.com/drugs-in-bugs-69-pharmaceuticals-found-in-invertebrates-living-in-melbournes-streams-106331
EPA Clinical and Related Waste Operational Guidelines, September 2009
• All cytotoxic and pharmaceutical waste must be incinerated
• “This excludes:
• materials containing trace quantities of pharmaceuticals (other than cytotoxics), eg. empty pill bottles
• saline, sugar, and nutrient solutions and drips”
https://www.epa.vic.gov.au/~/media/Publications/IWRG612%201.pdf
Drugs, Poisons & Controlled Substances Regulations 2017
Part 14: Destruction of Schedule 8 poisons• Specifies who may destroy S8s
• Registered nurses/midwives – only partially used contents of a “previously sterile container” (eg. ampoule) or tablet/lozenge
• Documentation requirements
Victorian DHHS Guidance: Managing Drugs of Dependence by Health Service Providers, April 2018
• Must be rendered non-recoverable and non-identifiable
• Partially used ampoules should not be placed in sharps containers –they may be recovered out of the container
https://www2.health.vic.gov.au/about/publications/policiesandguidelines/managing-drugs-of-dependence-by-health-service-providers
Advice from the Victorian Drugs and Poisons Regulation for disposal of Drugs of Dependence
• If S8 medicines are not rendered ‘non-recoverable’ and ‘non-identifiable’:
• 2 authorised persons may accompany S8 medicines to waste company to oversee destruction
• Or, the health service provider should ensure no S8 medicines are sent this way. “There are no waste companies in Victoria that have lawful authority to be in the possession of substances that are identifiable as Schedule 8 medicines.”
• Use drug disposal kits which utilise a chemical neutralizing agent
Which bin do I put it in?
WHCG Medication Disposal Clinician Survey
n = 39 nurses
Daniels Pharmasmart Containers
• P22 (14.5 Litres)
• contains absorbent mat (capacity 150 mL)
• can be used to dispose of drawing up needles, broken ampoules, partly emptied glass vials, tablets and capsules
• safety tray prevents access during use
• permanent locks on the side to engage once full
Issues identified at WHCG with P22 Pharmasmart
• No other sizes available
• Containers are not incinerated, only the contents
• Residual cleaning agent
• Partly used S8/S4Ds – disposal problematic
• Cannot dispose of large volume IV fluid bags
• Bedside medicine disposal, eg. patches
Daniels P64 (57 Litre)• No safety tray
• Additional temporary security lock/key available
• Permanent locks on the side to engage once full
• No absorbent pad
Does the bar-code mean that Pharmasmart bins can be traced?
- No, Daniels advised that the bar-codes on the bins cannot be used to ‘trace’ bins.
Developed for disposal of S8 and S4D medicines
Source: Drug Waste International website
Source: Drug Waste International website
Drug Waste Bins
Bin Type Disposal capacity Other information
Liquid 565 mL 170 mL
Liquid 2 Litre 1,700 mL Solid lid or lid with holeShelf life up to 7 days
Tablet/Capsule 565 mL 60 – 80 tabs/caps May not work immediately
Bin Type Disposal capacity Other information
Liquid 565 mL 170 mL
Liquid 2 Litre 1,700 mL Solid lid or lid with holeShelf life up to 7 days
Tablet/Capsule 565 mL 60 – 80 tabs/caps May not work immediately
Source: Brennan Fitzpatrick, RMH, Clinical Pharmacist – Perioperative Services
Potential issues with Drug Waste Bins
• Must dispose of via secure incineration
• Not environmentally friendly due to plastic waste
• Enviro DWB in development
• Tablet/capsule DWBs
• Quantity of tablets may be small
• May take 24 hours for effect – secure storage required
Cost Comparison
Bin Type Cost Other information
S22 Sharpsmart $26.52 each supply + collect HPV
20 L Pail $8.61 supply only + $1.23 per kg to collect HPV (collection only)
P22 Pharmasmart $34.50 each supply + collect Non-HPV
P64 Pharmasmart $57.09 each supply + collect HPV
Liquid Drug Waste Bin (2L) $21.50 each Website order
Liquid Drug Waste Bin (565 mL) $4.89 each (for 280) or $5.89 each (for 140) Website order
Tablet/Capsule DWB $3.89 each (for 280) or $4.19 each (for 140) or $5.89 each (for 20)
Website order
NB: Prices (except for DWBs) will vary for hospitals depending on location and contract arrangements.
Where should you dispose of these medicines?Pharmaceutical Waste Suggested appropriate disposal methodHalf Endone® tablet Options:
1) Pharmasmart (after crushing)
2) Drug Waste Bin (tablet/capsule)Contents of partly used morphine ampoule Options:
1) Drug Waste Bin (liquid)
2) Pharmasmart (contents must be withdrawn from ampoule)
Empty cefazolin (antibiotic) vial General wasteParacetamol tablet refused by patient PharmasmartUsed Norspan® patch Pharmasmart (folded, adhesive side together)
Contents of partly used epidural infusion bag Options:
1) Drug Waste Bin (liquid)
2) Pharmasmart (liquid soaked in absorbent material)
Contents of partly used bag of Glucose 5% Flush down the sink; empty bag into general waste or PVC recycling
Partly used Salbutamol inhaler Pharmasmart (canister)
Plastic component into general wastePartly used Novorapid® pen PharmasmartAntibiotic mixture that is no longer required Pharmasmart (entire bottle)
Recycling22%
Clinical13%General
65%
Volumes
Recycling10%
Clinical55%
General 35%
Costs
3.5kg per patient treated
$15 million
Victorian hospital waste 2017-18
Incinerated waste
Cytotoxic waste
Contaminated with a cytotoxic drug
Anatomical waste
Human tissue
Pharmaceutical waste
Any substance, other than saline, sugar or nutrient solutions.
Unless all extractable contents removed
All schedule 8 drugs of addiction
Sterilised waste
Sharps waste
Anything able to cut or penetrate the skin
Clinical waste
Any visible blood
From patient known to, or suspected of having, a communicable disease
Body fluids (can be flushed as per standard precautions)
Non-hazardous waste
Recycling
Hard plastic, metal, glass, paper and cardboard
Landfill
Anything else
Recycling
Landfill
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