Transcript Non-Hazardous Waste

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Nursing Education and Research
Protecting People Reducing Risk
Pharmaceutical Waste
Why Do We Care About It?
•To comply with Federal, State and Local laws & regulations
•To comply with The Joint Commission standards
•To protect patients & staff
•To protect the environment
Objectives:
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.
Regulatory Requirements
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)
What is Pharmaceutical Waste?
Pharmaceutical waste is a drug that is:
• No longer used for its intended purpose
• To be discarded
Examples of Pharmaceutical Waste
Types of Pharmaceutical Waste in Patient Care Areas:
•Partial vials
•Partial IVs
•Partial syringes
•Discontinued medicines
•Unadministered medicines
•Patient prescriptions
A) True
B) False
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Hazardous Versus Non-Hazardous
Pharmaceutical Waste
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
 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
These waste streams stay the same.
Trace Chemo
Bulk Chemo
Controlled Substances
What is different? Pharmaceutical Waste
Only when there is medication left in a vial, syringe, ampoule or IV bag, pills and
capsules included
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- Compatibles
Identified by NDC’s
Aerosols
Cysteine HCL
Glycopyrrolate
Sporanox
Which of the following are pharmaceutical waste you are likely
to find in patient care areas?
A) Unadministered medications.
B) Partial vials of medications.
C) Partial bags of IV fluids.
D) All of the above.
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EPA RCRA Trace, Empty and Bulk
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.
A)
D)
A container is considered empty when all contents have been removed
and less than 3% of the volume is left.
The procedure for wasting a narcotic has changed according to the pharmaceutical
waste guidelines.
An empty container is disposed of in regular trash, unless it is coumadin or
nicotene.
A & C only.
E)
A,B & C.
B)
C)
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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)
What Drug Goes Where?
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
Waste Sort Codes
 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
Compatible and Non-Compatible Hazardous Waste
Container
Compatible Hazardous
 Majority of hazardous waste

(BKC)
•
What Does Not Go In the Container
 Controlled
Oxidizer In-Compatible
• Silver Nitrate Sticks
• Cyanide Antidote Kit
• (SPO) back to pharmacy
Substances
Corrosive Non-Compatible
Glycopyrrolate
Selenious Acid
(SPC) back to pharmacy
2 and 8 gallon
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 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 2
Column 1
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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Your answer:
A. Syringe used to administer a
demerol injection.
B. Expired vial of Humalog
Insulin.
C. The majority of compatible
hazardous waste
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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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