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Nursing Education and Research

Protecting People Reducing Risk

•To comply with Federal, State and Local laws & regulations

•To comply with The Joint Commission standards

•To protect patients & staff

•To protect the environment

Pharmaceutical WasteWhy Do We Care About It?

Given pharmaceutical waste guidelines, nursing staff will be able to:

Recognize pharmaceuticals identified as hazardous materials at Palmetto Health

Select the appropriate container for specified pharmaceutical waste

IAW guidelines.

Objectives:

Agencies involved in Rx waste regulation:

• Environment Protection Agency (EPA)Resource Conservation and Recovery Act (RCRA)

•Department of Transportation (DOT) • Drug Enforcement Administration (DEA)• Publicly Owned Treatment Works (POTW) • The Joint Commission (TJC)

Regulatory Requirements

Pharmaceutical waste is a drug that is:

• No longer used for its intended purpose

• To be discarded

What is Pharmaceutical Waste?

Types of Pharmaceutical Waste in Patient Care Areas:

•Partial vials

•Partial IVs

•Partial syringes

•Discontinued medicines

•Unadministered medicines

•Patient prescriptions

Examples of Pharmaceutical Waste

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A) TrueB) False

EPA Resource Conservation & Recovery Act (RCRA), 1976 •Commercial Chemical (Listed) Hazardous Waste P Listed - Acutely Hazardous U Listed - Toxic (Chemo)

• Characteristic Hazardous Waste Toxic, Ignitable, Corrosive, Reactive

• Non-Hazardous Waste

Hazardous Versus Non-Hazardous Pharmaceutical Waste

Not all medications are considered hazardous. 

The medications that this compliance applies to will be marked with a code. It applies to about 200 of the medications given at PHR. The codes will be labeled on the med packet, EMAR, and pyxis.  The containers will also be labeled with the same codes.

  If a medication does not have a code, treat it as normal. 

If it has a code, compare it to the codes on the containers and place it in that container.

Healthcare Waste Streams

What is different? Pharmaceutical WasteOnly when there is medication left in a vial, syringe, ampoule or IV bag, pills and

capsules included

Bulk Chemo

Trace Chemo

Controlled Substances

These waste streams stay the same.

Types of Pharmaceutical Waste

Characteristic Hazardous• Lantus • Humalog• Humulin N&R• Novalog • Flovent • Taxol

P – Listed • Epinephrine*• Nicotine Patches • Coumadin/Warfarin

U – Listed • Chemotherapy drugs• Cytoxan • Mutamycin

* State Specific

Dual Waste –Hazardous• Regulated medical waste with RCRA (Resource Conservation and

Recovery Act)hazardous drug• Live vaccine

Non Compatible• Unused Silver Nitrate

In- CompatiblesIdentified by NDC’s Aerosols Cysteine HCL Glycopyrrolate Sporanox

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A) Unadministered medications.

B) Partial vials of medications.

C) Partial bags of IV fluids.

D) All of the above.

RCRA (Resource Conservation and Recovery Act)

RCRA Empty - Both conditions must be met:• All contents removed via commonly employed practices

(pouring, pumping, aspirating)• Less than 3% of original weight by capacity if the container

is less than or equal to 110 gal

• So what does this mean to me? • Only hazardous drugs (they will be coded) that aren’t empty

need to go in a special container. All other drugs can be wasted as usual except for anything pertaining to coumadin and nicotene (including packaging). These two must be wasted in the approved container.

EPA RCRA Trace, Empty and Bulk

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A) A container is considered empty when all contents have been removed and less than 3% of the volume is left.

B) The procedure for wasting a narcotic has changed according to the pharmaceutical waste guidelines.

C) An empty container is disposed of in regular trash, unless it is coumadin or nicotene.

D) A & C only.

E) A,B & C.

What Does Not Change

Controlled Substances – Follow your hospital’s written policy.

Empty Items – Empty IVs, vials and syringes will continue to be disposed of according to current procedures. except coumadin & nicotine (treat empty containers as hazardous)

Sugar/Salt water IVs – Can still go down the drain: saline, glucose, dextrose, electrolytes, and lactated ringer’s. (No Medications Instilled)

Satellite Accumulation Containers

Color-Coded Containers for Partial/Full Meds

• Compatible Hazardous (Black Container)

• In- Compatible Hazardous (Black Container based on code)

• Units send back to pharmacy in baggie/tray unless a container is available)

Sort codes will be utilized to emphasize proper segregation for approximately 200 hazardous drugs. Non-coded items go into a non-hazardous container.

Nurses will be alerted by:

Waste Code NotificationOptions

•Rx Patient Label

•Dispensing machine (Pyxis)

•Cubies marked in (Pyxis) medication dispenser

for Coumadin and Nicotine Patches

•Patient Record Sheet (MAR)

•Black Dots on shelving to signify “hazardous” in

IV area

•Container Posters

What Drug Goes Where?

BKC = Black Compatible Hazardous Container Example: Humalog

SP = Black In-Compatible Hazardous Container Aerosols and inhalers

SPC = Black In-Compatible Hazardous Container (may be in OR or ED) Glycopyrrolate

SPO = Black In-Compatible Hazardous Container (may be in OR or ED) Unused Silver Nitrate Stick`

PBKC = Package captured in Black Compatible Container Coumadin/Warfarin and Nicotine

When you see “SP”, think “Send back to Pharmacy”The medications that are hazardous will have one of

these codes

Waste Sort Codes

Compatible and Non-Compatible Hazardous Waste ContainerCompatible Hazardous Majority of hazardous waste (BKC)

• What Does Not Go In the Container Controlled Substances

Aerosols/inhalers (SP code) will be returned to Pharmacy. In-Compatible hazardous waste containers are in the pharmacy and specialized areas such As OR and ED. Units send back to pharmacy in baggie/tray unless a container is available)

2 and 8 gallon

Oxidizer In-Compatible

• Silver Nitrate Sticks

• Cyanide Antidote Kit

• (SPO) back to pharmacy

Corrosive Non-Compatible Glycopyrrolate Selenious Acid(SPC) back to pharmacy

2 Gallon Black Sharps Container

What Goes In the Black Sharps Container

• Syringes and ampules with bulk

pharmaceuticals that have not come into

direct patient contact, (infectious) and

are not a controlled substance.

2 gallon

Column 1 Column 2A. Syringe used to administer a

demerol injection.

B. Expired vial of Humalog Insulin.

C. The majority of compatible hazardous waste

C 1.Black 8 gal. non- sharp hazardous container.

A 2.Regular red sharps container.

B 3.Black 2 gallon sharps container

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Hazardous Storage Area (CAA)

• Environmental Services transfers full RX containers to CAA (Central Accumulation Area - Hazardous waste storage area), replaces container in SAA (Satellite Accumulation Area) with empty.

Nurses Action: Contact environmental Services when the containers are becoming full – Do not let containers overflow.

RX Waste Compliance Program

Conclusion

Recognize pharmaceuticals identified as hazardous materials at Palmetto Health

Select the appropriate container for specified pharmaceutical waste

Summary RX Waste Compliance Program

Pertains to non-reusable, partial/full pharmaceutical waste only

Waste medication to be identified by black dots and/or sort codes on: Rx Patient Label Dispensing machine (Pyxis) Cubies marked in (Pyxis) medication dispenser

for Coumadin and Nicotine Patches Patient Record Sheet (MAR) Black Dots on shelving to signify “hazardous” in IV area

Sort codes: BLK, SP, SPC, SPO, PBKC will indicate which container the nurse should put the med in. If there is no code it goes in a regular container.

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