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Pharmaceuticals & Health CareHawaii Health Care Pollution
Prevention Workshop
Janet BrownDirector, Facility Engagement
Practice Greenhealth
Practice GreenhealthPractice Greenhealthto educate, motivate, and engage healthcare professionals to adopt best environmental practices that increase operational efficiency and support an environmentally sustainable system that improves the health of patients, staff and the community…
S U S T A I N A B I L I T Y T R A I N I N G
PGH members Kaiser Permanente* Veterans Administration* U.S. Army, Tripler Medical Center* Hawaii Department of Health/Environmental
Health Full list of members: http://www.practicegreenhealth.org/community/
members/* Practice Greenhealth Environmental Excellence Award Winners
S U S T A I N A B I L I T Y T R A I N I N G
Pharmaceutical Waste Management
Pharmaceuticals and Environmental and Public Health Impacts
Green Guide for Health Care Pharmaceutical Prevention Opportunities Resources
S U S T A I N A B I L I T Y T R A I N I N G
Green Team Pharmacy Environmental Nursing Administration Safety Education Purchasing Risk Management
S U S T A I N A B I L I T Y T R A I N I N G
EC Research has picked up speed since 1998EC Research has picked up speed since 1998
Slide Provided by Dana Kolpin, US Geological Survey. Glassmeyer et al., 2008
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50
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150
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250
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
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Environmental Impact U.S. Geological Survey
Emerging Contaminant Project
www.toxics.usgs.gov/regional/emc
Associated Press Investigation Emerging Pollutants and Chemicals in
the Environment Renewable Resources Journal, C. Daughton, www.rnrf.org -
Environmental Health News
http://www.environmentalhealthnews.org/
S U S T A I N A B I L I T Y T R A I N I N G
8
constructionmanual
1 – Integrated Design2 – Sustainable Sites3 – Water Efficiency4 – Energy & Atmosphere5 – Materials & Resources6 – Indoor Environmental Quality7 – Innovation
2 - 21 - 181 - 73 - 192 - 242 - 220 - 4
11 - 94
www.gghc.org
S U S T A I N A B I L I T Y T R A I N I N G
operationssection
1 – Integrated Operations2 – Sustainable Sites Management3 – Transportation Operations4 – Facilities Management5 – Chemical Management6 – Waste Management7 – Environmental Services8 – Food Service9 – Environmentally Preferable Purchasing10 – Innovation in Operation
S U S T A I N A B I L I T Y T R A I N I N G
Chemical Management
Prereq 1 – Polychlorinated BiPhenyl (PCB) Removal andAsbestos-Containing Materials (ACM) ManagementPrereq 2 – Chemical Management Policy and AuditPrereq 3 – Community Contaminant Reduction: Leaks & SpillsCredit 1.1 Indoor Chemical Contaminant Reduction: Sanitary Sewer Credit 1.2-1.4 - Indoor Chemical Contaminant Reduction: HandHygiene Products, Sterilization & High Level DisinfectionCredit 1.5 - Indoor Chemical Contaminant Reduction: LaboratoriesCredit 1.6 - Indoor Chemical Contaminant Reduction: RadiologyCredit 2.1-2.2 – Pharmaceutical Minimization, Management & Disposal
S U S T A I N A B I L I T Y T R A I N I N G
2.1 & 2.2 Pharmaceutical Minimization, Management and Disposal Formulary Review Process Develop and implement a policy and program for
receipt, handling, storage, labeling, transport and disposal of pharmaceuticals, including staff education and training.
Pharmaceutical waste prevention
www.gghc.org
S U S T A I N A B I L I T Y T R A I N I N G
Pharmaceutical Waste Prevention PGH Webinar on Pharm Waste Preventionhttp://www.practicegreenhealth.org/tools/webinars/archive/archive/406 PGh Webinar on Blueprint Update, USGeological
Survey, Stericycle and Albany Med Case Study
www.practicegreenhealth.org/tools/webinars/archive/archive/456 *
* Membership Benefit
S U S T A I N A B I L I T Y T R A I N I N G
Pharm Waste Prevention Case Study
Catherine Zimmer, MntapWww.mntap.umn.edu/health/94-PharmWaste.htm Tri-County Hospital and Hennepin County Medical
Center (HCMC)• Stock Rotation • Alternate Packaging• Operating Room• Purchasing/Inventory Management• Reverse Distribution
S U S T A I N A B I L I T Y T R A I N I N G
Top Ten Returns in Reverse Distribution at HCMC and Tri-County
* HCMC Tri-County Hospital
12. 3. Lantus 4. Glutose gel Morphine* Resource: Minnesota Technical Assistance Program
HCMC saved $70,000 Tri-County saved $30,000
Crash box epinephrine Combivent
Epinephrine Humalog
Glucagen Lantus
Glutose gel Morphine sulfate
Nitrostat Novolog
Hydralazine Pneumovax
Lidocaine Synthroid
Amiodarone Cetacaine
Adenosine Ketamine
Naloxone Nubain
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Free Drug Sample Prevention Case Study Cook Area Health Services Intern Project in Minnesota to address prevention
of free sample drug waste. Voucher Option
Resource: Catherine Zimmer, Minnesota Technical Assistance Program
S U S T A I N A B I L I T Y T R A I N I N G
Typical drugs collected:1. propofol2. lidocaine3. succinylcholine4. bupivacaine5. lidocaine/epinephrine6. benzoin swabsticks (77%
alcohol)-g7. ephedrine8. epinephrine
9. atracurium10. proparacaine11. bupivacaine/epinephrine12. Atropine
* Resource: Albany Medical Center
13. lidocaine/marcaine 14. omnipaque15. bacitracin-g16. phenylephrine17. dye18. vancomycin-g19. gadodiamide20. heparin21. unknown22. neostigmine23. lidocaine jelly24. diatrizoate meglumine25. cefazolin
81%
95%
S U S T A I N A B I L I T Y T R A I N I N G
Drugs Wasted (top 85%):
* Albany Medical Center
S U S T A I N A B I L I T Y T R A I N I N G
Process Improvement – Propofol (Diprivan®)Injectable anesthetic agent. Suspension supplied in 20, 50 or 100 mL vials.9 of 9 for persistence, bioaccumulation and toxicity
(Environmentally classified pharmaceuticals, http://ww.janusinfo.se).
Comprise 41% of the total waste generated (each case = new vial).
Solution: 50 and 100 mL vials of propofol were removed from AMC Pharmacy inventory.
Propofol only dispensed 20 mL.
Resource: Albany Medical Center
S U S T A I N A B I L I T Y T R A I N I N G
Documentation examples Compile and annually review of formulary Annually update policy, staff training Annually review prevention practices Annually update implementation of best management
approach to non RCRA pharmaceuticals. Collect and track data on volumes and kinds of
pharmaceuticals generated Track pharmaceutical samplesPages 08-25 through 08-28
S U S T A I N A B I L I T Y T R A I N I N G
Resources• NIOSH Hazardous Drug Alert
http://www.cdc.gov/niosh/docs/2004-165/#sum
• ASHP Guidance on Handling Hazardous Drugshttp://www.ashp.org/s_ashp/bin.asp?CID=6&DID=5420&DOC=FILE.PDF
• OSHA Technical Manualhttp://www.osha-slc.gov/dts/osta/otm/otm_vi/otm_vi_2.html
• Practice GreenHealth www.practicegreenhealth.org/ 2008 10-Step Blueprint for Health Care Facilities in the United StatesPharmaceutical waste webpage:
Teleosis - http://www.teleosis.org/gpp-pollution.php Pharmaceutical Report Findings
U.S. Geological Surveyhttp://pubs.acs.org/cgi-bin/jtextd?esthag/36/6/html/es011055j.html
S U S T A I N A B I L I T Y T R A I N I N G
Join the Community http://cms.h2e-online.org/listserv List Serve
S U S T A I N A B I L I T Y T R A I N I N G
Thank you!
Janet Brown – 413/[email protected]
www.practicegreenhealth.org
