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Albany Medical Center. Pharmaceutical waste management: A 2 year pilot project Funded by the US EPA grant X9-97256506-0 In collaboration with HANYS (Healthcare Association of New York State) and the New York State Department of Environmental Conservation. Russell F. Mankes, PhD

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Albany Medical Center

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Albany medical center

Albany Medical Center

Pharmaceutical waste management:

A 2 year pilot project

Funded by the US EPA grant X9-97256506-0

In collaboration with HANYS (Healthcare Association of New York State) and the New York State Department of Environmental Conservation

Russell F. Mankes, PhD

Associate Professor, Center for

Neuropharmacology and Neuroscience and

Center for Immunology and Microbial Disease


Metrics amc scc formulary characterization

MetricsAMC-SCC Formulary characterization


Waste accumulation

Waste Accumulation

  • Containers?

    • Size ?

    • Number ?

    • Location ?

    • Type ?

    • Liners ?

    • Liquids ?

    • Labeling& closures ?

    • Mounting?

4 gallon compatible

Waste container

2 gallon incompatible

Waste container


Waste segregation

Waste Segregation

  • Time consuming & Labor intensive – 2 staff members x 15 minutes / container.

  • High level of training required to identify drugs.

  • High level of security & regulatory approval for staff by New York State required as controlled substances are commonly found in the pharmaceutical waste bins (despite the label no controlled substances).

  • Sharps maldisposals into pharmaceutical waste make waste sorting hazardous and PPE is required


Education

Education


Model education plan cont d

Model Education Plan (cont’d)

  • Outcome: Managers and Directors hold staff accountable for incorporating change into practice.

  • Metrics:

    • Post test – 80% minimum passing. Completion rates for each job title, 99% target rate. New hires must receive training at hire.

    • Random trainee follow-ups. Correct response rates below 80% trigger retraining.


Preliminary results

Preliminary Results

  • 5/9/08 – 9/10/08 (118 days)

  • 40 containers from 8 OR’s Post-Op; Pre-Op, MRI, Patient care floor and a Surgical practice site

  • 0.04 lbs/container/day

  • Total weight 188.2 pounds

  • 4.6 pounds RCRA

  • 168.2 pounds Non-RCRA

  • Propofol most common (28%) non-RCRA medication

  • 250 sharps

  • 147 Antibiotics (3.9 pounds)

  • 75 Controlled substances (1.0 pound)

  • Costs per pound (RCRA contractor):

    • RCRA pharmaceutical waste $156 - $3.52;

    • RCRA chemotherapeutic waste $6.07;

    • Non-RCRA pharmaceutical waste for incineration only $4.37 – $2.23.

  • Stericycle = $0.36/lb (Incinerate only).

  • 20 hr for labor in waste sorting (2 persons [1 PhD, 1 BS] * 0.25 hr per container)


Preliminary results cont d

Preliminary Results (cont’d)


Preliminary results cont d typical drugs collected

propofol

lidocaine

succinylcholine

bupivacaine

ephedrine

Sensorcaine-80%cumulative percent

lidocaine-epinephrine

epinephrine-NYS RCRA

marcaine

proparcaine

atracurium

polocaine

atropine

vancomycin-Ab

mepivicaine/marcaine/hydase

lidocaine jelly

Dye-RCRA

edetate

heparin

gonak

glycopyrrolate

betadine

Ondansetron – Eco Hazard

labetalol

bacitracin-Ab

dexamethasone

fentanyl-CS

midazolam-CS

neostigmine

xylocaine/marcaine

ancef-Ab

cefazolin-Ab

neomycin ointment-Ab

gentamicin-Ab

phenylephrine

brimonidine

solumedrol

ketorolac

lincomycin-Ab

tetracaine

ceftazidime-Ab

cyclopentolate

diphenhydramine

Preliminary Results (cont’d)Typical drugs collected:


Preliminary results cont d1

Preliminary results (cont’d)

Process Improvement – Propofol (Diprivan®)

Propofol is an injectable anesthetic agent used for outpatient or inpatient surgical procedures or to provide conscious sedation. It is a suspension in liquid supplied in 20, 50 or 100 mL vials. It is considered a 9 of 9 for persistence, bioaccumulation and toxicity (Environmentally classified pharmaceuticals, http://ww.janusinfo.se). During waste segregation, propofol was found to comprise 29% of the total waste generated from the operating rooms as for each case required a new vial of propofol to be opened and all propofol from the preceding case to be discarded.

Solution: 50 and 100 mL vials of propofol were removed from AMC Pharmacy inventory. Propofol would only be available in the smallest size manufactured to reduce wastage.


Problem areas

Problem Areas

  • Security & Controlled substance disposal, e.g., Chloral Hydrate & Paraldehyde RCRA & DEA Regulated, “wasting” of narcotics into toilet, sink.

  • Pain Management, HIV Medicine have a medical need to verify patient disposal of excess pain medications

  • Diagnostic Radiology – Barium Waste

  • Mixed Wastes (vaccines)


Contact information

Contact Information

  • Russell F. Mankes, PhD, Assoc Prof, MC-96, Albany Medical Center, 43 New Scotland Ave, Albany, NY 12208

  • Telephone: 518-262-5490

  • To request PDF documents of presentation or supplementary information, e-mail request to [email protected]


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