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