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December 2009 Vol. 6 No. 12
HARMACY
Purchasing&Products
Stericycle
28161 N Keith Dr, Lake Forest, IL 60045
847-367-5910 • www.stericycle.com
From the Editorial Director Deanne Halvorsen
T
he challenges that led Thomas Jefferson University Hospitals
(TJUH) to seek external assistance for pharmaceutical waste annual report. TJUH identifies drugs on patient labels and in ADCs
disposal compliance were common enough. Most hospitals using simple codes on each container, thereby ensuring proper dis-
are concerned with EPA and The Joint Commission (TJC) posal.
compliance, as well as the liability of potential harm to I On-site education of pharmacy, nursing, and EVS staff: Staff were
patients, staff, visitors, and the environment. At TJUH—which includes the educated on how to properly interpret the simple waste codes with
main campus with 750 beds, Methodist Hospital with 250 beds, and a particular focus on proper disposal of partial IVs with instilled
Jefferson Hospital for Neuroscience with 120 beds—the pharmacy operation medication. Continued drain disposal of “plain” IVs (electrolytes,
is decentralized to meet the needs of each facility. We wanted our pharma- saline, and dextrose) and proper disposal of controlled substances
ceutical waste program to effectively do the same. also was reinforced.
While the initiation of a pharmaceutical waste program was led by our
I Implementation of color-coded, reusable containers: Having a vari-
environmental services (EVS) and pharmacy departments, the process
involved a multi-departmental “pharmaceutical work group.” This group— ety of container sizes and mounting options (wall brackets, floor dol-
consisting of representatives from nursing, nurse education, accreditation, lies, etc) allowed us to address challenges related to space.
facilities, risk management, safety and health, infection control, informa- I Transportation and destruction: Stericycle technicians collect and
tion systems, and sustainability—was collectively excited about the various bring full containers to a central accumulation area a few times each
benefits of such a program. Their cooperation was integral to the success- week where they pack the waste. The fully packed containers are
ful implementation. picked up from this location on a weekly basis. The pharmaceutical
work group identified an adequate waste storage area and enlisted
In-house vs. Outsource administrative support in raising awareness and acceptance of the
We wanted to get ahead of the compliance curve by initiating a program that program.
linked our organization’s goals with TJC standards and regulatory require-
ments. Given the complexity and sensitivity of TJC’s 21 hospital standards, we TJUH’s main campus began this process in November 2008 with manda-
knew a comprehensive turnkey solution was necessary. tory training for anyone handling hazardous waste. The training process took
The first step in this process was to determine which pharmaceuticals were just two days. Later, new employee orientation and employee yearly compe-
hazardous and if proper disposal could be managed in-house. We also consid- tency reviews were added.
ered non-hazardous drugs that are damaging to the environment. We decided
that the potential cost and risk to staff was such that an outsourced provider Results
would be our best option. We wanted a service that could provide a waste Our six-month pilot phase at TJUH included 150 beds and all inpatient
characterization that segregated the formulary by EPA and DOT waste pharmacies. With effective training, waste coding of all pharmaceuti-
streams and identified the compatibility of hazardous and non-hazardous cals, and the use of color- coded containers, in its first year, the fully
pharmaceuticals based on chemical content. implemented program dramatically minimized disposal costs, as only
3,000 pounds of the roughly 75,000 pounds of pharmaceutical waste
Finding the Right Vendor collected was RCRA hazardous. The response from staff also has been
Some vendors we reviewed had program plans and characterization capabili- quite positive, with high visibility to the CEO and executive suite. Thus
ties, others focused on hazardous waste disposal only. We wanted a vendor far, we have had success in meeting our goals, which included exceed-
with national experience that could share best practices and coordinate cost ing the standards for regulatory compliance, mitigating costs, keeping
containment strategies with us. We chose Stericycle’s pharmaceutical waste harmful pharmaceuticals out of the public water supply, and focusing
compliance program in part because it uses a system of checks and balances on the safety and health of our staff, patients, visitors, and the commu-
to assess where we are and where we need to be. Implementing the program nities we serve.
involved a four-phase approach:
I Identification of formulary characterization and waste coding: Michael Roshko, PharmD, is the operations manager for Thomas
Stericycle provided the characterization within one week of submit- Jefferson University Hospital in Philadelphia, Pennsylvania. He is
ting our formulary, and continues to provide updates as we add new responsible for all inpatient pharmacy services.
Reprinted with permission from Pharmacy Purchasing & Products, Vol. 6 #12. ©2009 Ridgewood Medical Media, LLC, Ho-Ho-Kus, NJ. All rights reserved.
Sustainable Solutions
SM
Concerned
Con
ncerned
erned The Stericycle
Stericyycle integrated
integrated approach
app
proach includes:
about pharma
ppharmaceuticals
ph aceuticalss in the water?
w ?
s Formulary
Formullary characterization
characterization and
annd coding;
Uncertain
Unc
certain
rtain s On-sitee education of healthcare
healthcaare facility staff;
of how to appropriately
ppropria
s Implementation
Implem
mentation and accumulation
accumulation of color
dispose off pharmaceuticals?
armac
coded containers; and
s Transportation
Transportation and destruction.
destructioon.
Aware
A
Aw
Awar
re
of The
The Joint Commission
Com
mmission 2010
20 Standards?