Pharmaceutical Waste Program

1. Pharmaceutical Waste Program Portland Service Area 2011

2. What is Pharmaceutical Waste? • Waste that is generated through the preparation and/or administration of pharmaceutical agents. This includes partially used vials, syringes, and IV bags; medication inhalers and aerosols; and discarded medications.

3. What Happens to Pharmaceutical Waste? • Currently, nearly all pharmaceutical waste is disposed in sharps containers and treated similarly to other forms of waste. Because of this, it ends up in landfills, rivers, streams, and oceans.

4. And Then What Happens to It? • In recent years, pharmaceutical waste has been found in a wide variety of animal and human food and water sources. There is mounting concern about the long-term consequences to our health and the environment .

5. What is the Solution? The solution is to separate pharmaceutical waste from other forms of waste and dispose of it appropriately. This will help us to: • Keep pharmaceutical waste out of our groundwater and landfills and to reduce potential harmful effects to our environment • Minimize the risks associated with managing hazardous medications • Comply with current and future regulatory requirements regarding the disposal of pharmaceutical waste

6. We are part of the solution! Providence Health and Services has made the decision that all pharmaceutical waste generated by our facilities must be discarded in special bins so that we can process and dispose of it in an environmentally sound fashion. • How the pharmaceutical waste must be handled depends upon whether or not it is classified as hazardous waste. • Hazardous pharmaceutical waste must be identified and disposed of separately from all other pharmaceutical waste.

7. Hazardous Pharmaceutical Waste • Medications which can pose a substantial hazard to human health or the environment when not properly managed. These have been identified by the Environmental Protection Agency and other environmental health agencies as requiring special disposal methods • Toxic and flammable chemicals • This includes all chemotherapeutic agents as well as a small number of other medications such as: Nicotine, Physostigmine, Warfarin, Insulin, Metronidazole • Flammable aerosols • This includes all aerosol inhalers

8. Non-Hazardous Pharmaceutical Waste • All other medications are classified as non-hazardous pharmaceutical waste. • This does not mean that they are not harmful to the environment, it simply means that they are not on the list of medications that are regulated by the Environmental Protection Agency or are classified as highly toxic. • This waste will also be disposed of in an environmentally sound manner.

9. How does this work? Providence is utilizing 3 different types of containers to segregate waste. • Black Bin (Hazardous pharmaceutical waste) • Yellow Bin (Trace chemotherapy waste) • White Bin (All other pharmaceutical waste) Pharmaceutical waste collection bins will be located in med rooms and soiled utility rooms

10. Black Bins for Hazardous Waste All hazardous waste must be disposed of in a BLACK bin. • All vials, IV bags, tablets or patches containing residual hazardous drugs, including bulk chemotherapy, must be discarded in a black bin • Aerosols must be kept separate from all other hazardous materials and so they will be disposed of in a special black bin (labeled “aerosols”). • Unused syringes containing hazardous drugs will also be disposed of in a special black “dual waste” bin (black sharps container).

11. Three Special Cases • 3 hazardous drugs are specially regulated by EPA: • Warfarin • Arsenic Trioxide • Physostigmine • Empty vials or IV bags previously containing these 3 drugs in liquid form, must be disposed in black hazardous waste bins. • Empty wrappers from tablets of these 3 drugs can go in the white bin. • All other empty drug vials (glass and plastic) are disposed in white non-hazardous bins.

12. Black Bins for Hazardous Waste • The good news— Medication requiring black bin disposal will be noted in the comment field upon barcode scanning in Horizon Clinical • Screenshot of notification

13. Yellow Bins for Trace Chemo • Trace Chemo Only, including: • Empty vials, tubing, syringes, and iv bags, as well as gowns, gloves, wipes, and other items contaminated with trace amounts of chemotherapy drug. • Sharps contaminated with trace chemo

14. White Bins for Everything Else 1. All other drugs not identified as hazardous. • Including pills, vials and IV bags containing non-hazardous drugs • Exceptions: Non-med IV fluids (NS, LR, D5LR, D5NS20K, KCl) are disposed in the sink • All controlled substances discarded in the sink (and fentanyl patches go in the red sharps container) as per current practice. 2. Empty vials (glass and plastic) of hazardous and non-hazardous drugs • Exception: put empty containers of Warfarin, Arsenic Trioxide and Physostigmine inblack hazardous waste bin.

15. What doesn’t go in a special bin? • Empty IV bags, tubing, and other types of packaging without patient identifiers may be discarded in the trash as per current practice. • Empty means “empty by normal means.” A few drops left in a bag or a few cc’s of medication retained in the IV tubing is considered empty. • Empty or partly used syringes should be placed in the red sharps container as per current practice. • IV fluids (NS, LR, D5LR, D5NS20K, KCl) and All controlled substances will be discarded in the sink (and fentanyl patches go in the red sharps container), as per current practice.

16. Frequently Asked Questions: • Why will we continue to dispose of controlled substances in the sewer? • The DEA requires disposal of controlled medication in a secure manner. • By removing other hazardous drugs from the sewer system, we will significantly improve our current practice. • As environmental regulations evolve, we may find ways to improve controlled waste disposal practices.

17. Pharmaceutical Waste and Disposal Hazardous Drugs, Bulk Chemo, & empty vials & IV bags that contained Warfarin, Arsenic Trioxide and Physostigmine Trace Chemo Used or partly-used syringes and vaccines UNUSED syringes containing hazardous drugs Aerosols (inhalers) All other drugs, & empty containers Aerosol

18. Identifying Black Bin Drugs • Medication requiring black bin disposal will be noted in the comment field upon barcode scanning in Horizon Clinical. • This note will also appear on the label of patient-specific medications delivered from pharmacy. • Screenshot: “black bin disposal”

19. Frequently Asked Questions: • Why is one dosage form of a drug on the list when another form is not? (for example: prednisolone ointment is on the hazardous drugs list but the tablets are not) • Some drugs are regulated because of the preservatives or additives they contain (mercury, for example), not because of the toxicity of the medication itself. • Just because one drug from a particular class is on the “hazardous” list does not mean all other drugs in that class are also hazardous.

20. Frequently Asked Questions: • Why can’t I throw pills in a sharps container? • Sharps containers are disposed of in the landfill and hazardous waste needs to be incinerated to protect the environment. • How should I carry pills to the white bin? • Carry medication back the way it came (put pills back in the original package or cup)

21. Frequently Asked Questions: • What should I do with sharps or used syringes containing hazardous drugs? • If the syringe is full and has never been used (expired drug, for example), dispose in the black sharps container located in med room. • If the syringe has been used at all, dispose in the red sharps container, even if residual drug remains. UNUSED syringes containing hazardous drugs USED syringes of all types

22. Frequently Asked Questions: • What should I do with sharps or used syringes containing chemotherapy drugs? • Syringes used for chemo drugs are disposed of in the yellow trace chemo bin, as per current practice. Trace Chemo

23. Frequently Asked Questions: • What should I do with IV bags? • Empty IV bags can go in the trash, as long as they don’t have patient identifiers on the label • If an empty IV bag includes patient identification, dispose of it in the white bin. • EXCEPTION: Empty IV bags previously containing arsenic trioxide (one of the 3 “special drugs”) go in the black bin. • IV bags with residual medication go in the black bin, if the label says “black bin disposal”, or in the white bin if there is no indication on the label.

24. Take home points • We have made the decision to dispose of our pharmaceutical waste in an environmentally sustainable manner. • All pharmaceutical waste will go in one of three containers. • If the EMAR says “Black Bin Disposal” or it’s an orange-label chemo drug, discard full or part-full containers in a black bin. • Trace chemo goes in a yellow bin. 3. Non-hazardous drugs and empty containers go in a white bin

25. Take home points If the EMAR says “Black Bin Disposal”: • All aerosol inhalers go in black bin labeled “aerosol” • Empty vials or IV bags previously holding liquid warfarin, arsenic trioxide or physostigmine go in black bins.

26. Take home points If it’s a chemo drug: • Bulk chemo goes in black bin • Including full or part-full vials and iv bags • Also including empty arsenic trioxide iv bags • Trace chemo goes in the yellow bin: • Including sharps used for chemo, PPE and empty containers • “Trace” is defined as “empty by normal means” and no more than 3% of volume remaining in the container Bulk Chemo Trace Chemo

27. Take home points If it’s NOT a hazardous drug: • Non-med IV liquids go down the drain (including dextrose, lactated ringer, electrolytes, Ca/K/Mg piggybacks). • Controlled substances go down the drain (fentanyl patch down the drain), following usual procedure.

28. Frequently Asked Questions: • Where are pharmaceutical waste bins located? • In med rooms and soiled utility rooms • Who is responsible for picking up and replacing full bins? • Environmental Services • What happens after the bins are picked up? • Black bins are shipped to a regulated hazardous waste incinerator. • White bins are shipped to a regulated medical waste incinerator. • Red sharps containers are autoclaved and disposed in a landfill.

29. Questions? • See your unit manager for more information