Pharmaceuticals & Health Care Hawaii Health Care Pollution Prevention Workshop Janet Brown Director, Facility Engagement Practice Greenhealth
Practice Greenhealth to 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
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/memb * Practice Greenhealth Environmental Excellence Award Winners SUSTAINABILITY T RAINING
Pharmaceutical Waste Management Pharmaceuticals and Environmental and Public Health Impacts Green Guide for Health Care Pharmaceutical Prevention Opportunities Resources
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Green Team
Pharmacy Environmental Nursing Administration Safety Education Purchasing Risk Management SUSTAINABILITY T RAINING
EC Research has picked up speed since 1998 250 200 150 100 50 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Slide Provided by Dana Kolpin, US Geological Survey. Glassmeyer et al., 2008 SUSTAINABILITY T RAINING
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.environmentalhealthnew
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1 2 3 4 5 6
– – – – – –
Integrated Design Sustainable Sites Water Efficiency Energy & Atmosphere Materials & Resources Indoor Environmental Quality
7 – Innovation
www.gghc.org
2 1 1 3 2 2 0 11
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2 18 7 19 24 22 4 94
construction manual
8 SUSTAINABILITY T RAINING
1 – Integrated Operations 2 – Sustainable Sites Management 3 – Transportation Operations 4 – Facilities Management 5 – Chemical Management 6 – Waste Management 7 – Environmental Services 8 – Food Service 9 – Environmentally Preferable Purchasing 10 – Innovation in Operation
operations section SUSTAINABILITY T RAINING
Chemical Management Prereq 1 – Polychlorinated BiPhenyl (PCB) Removal and Asbestos-Containing Materials (ACM) Management Prereq 2 – Chemical Management Policy and Audit Prereq 3 – Community Contaminant Reduction: Leaks & Spills Credit 1.1 Indoor Chemical Contaminant Reduction: Sanitary Sewer Credit 1.2-1.4 - Indoor Chemical Contaminant Reduction: Hand Hygiene Products, Sterilization & High Level Disinfection Credit 1.5 - Indoor Chemical Contaminant Reduction: Laboratories Credit 1.6 - Indoor Chemical Contaminant Reduction: Radiology Credit 2.1-2.2 – Pharmaceutical Minimization, Management & Disposal SUSTAINABILITY T RAINING
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 SUSTAINABILITY T RAINING
Pharmaceutical Waste Prevention PGH Webinar on Pharm Waste Prevention
http://www.practicegreenhealth.org/tools/webinars/archi PGh Webinar on Blueprint Update, USGeological Survey, Stericycle and Albany Med Case Study
www.practicegreenhealth.org/tools/webinars/archive/a * * Membership Benefit
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Pharm Waste Prevention Case Study Catherine Zimmer, Mntap Www.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 SUSTAINABILITY T RAINING
Top Ten Returns in Reverse Distribution at HCMC and Tri-County 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
* HCMC Tri-County Hospital
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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 SUSTAINABILITY T RAINING
Typical drugs collected:
1. 2. 3. 4. 5. 6.
propofol lidocaine succinylcholine bupivacaine lidocaine/epinephrine benzoin swabsticks (77% alcohol)-g
7. ephedrine 8. epinephrine 9. 10. 11. 12.
81%
atracurium proparacaine bupivacaine/epinephrine Atropine
13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.
lidocaine/marcaine omnipaque bacitracin-g phenylephrine dye vancomycin-g gadodiamide heparin unknown neostigmine lidocaine jelly diatrizoate meglumine cefazolin
95% * Resource: Albany Medical
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Drugs Wasted (top 85%):
* Albany Medical Center
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Process Improvement – Propofol (DiprivanŽ) 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
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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 samples Pages 08-25 through 08-28 SUSTAINABILITY T RAINING
Resources • NIOSH Hazardous Drug Alert
http://www.cdc.gov/niosh/docs/2004-165/#sum
• ASHP Guidance on Handling Hazardous Drugs http://www.ashp.org/s_ashp/bin.asp? CID=6&DID=5420&DOC=FILE.PDF
• OSHA Technical Manual
http://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 States Pharmaceutical waste webpage:
Teleosis - http://www.teleosis.org/gpp-pollution.php Pharmaceutical Report Findings
U.S. Geological Survey
http://pubs.acs.org/cgi-bin/jtextd?esthag/36/6/html/es011055j.html SUSTAINABILITY T RAINING
Join the Community http://cms.h2e-online.org/listserv List Serve
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Thank you!
Janet Brown – 413/253-0254 jbrown@practicegreenhealth.org www.practicegreenhealth.org SUSTAINABILITY T RAINING