Medication Education Module 2 Disposal Note to the Trainer: In all scenarios, Karen Mason is the name of the Supervisor. Trainer Preparation Copies of PowerPoint handout Print p. 2 “Objectives” to test staff knowledge before & after the training. (Use as your training documentation.) Copies of MAP Policy 10-5 and 10-6 [Disposal form] You could also make copies of the Drug Control Program (DCP) Inspection Tool http://www.mass.gov/eohhs/docs/dph/quality/drugcontrol/map/map-medication-security-inspection-form.pdf

Objectives 1. What does med disposal mean? 2. When would I dispose of meds? 3. How are meds disposed of? What I know about medication disposal before the training: 1. 2. 3. 4. What I learned about medication disposal after the training: 4. How many staff are needed?

Medication Disposal Purpose To make the medication useless Meds must be destroyed on site or at Provider main office. If disposal is done at a main office, a transfer form is needed when transporting to the office and both the transfer form and disposal records are maintained on site. Medication is never returned to a pharmacy for disposal.

Medication Disposal When Dropped Refused Expired Discontinued Person leaves These are examples of when meds are disposed of.

Disposal Methods Unless prohibited by local ordinance Read the med information sheet first to see if there are specific disposal instructions. If not Take the med out of original container Crush and/or dissolve in water in a sealable bag Mix with liquid soap, used coffee grounds or kitty litter Place sealable bag in non descript container Place in trash Following disposal remove all identifying personal information from label Only flush if the med information sheet provides that as a disposal option This is what staff are taught in certification training.

Disposal Process If the meds are expired or discontinued Disposal must be completed with 2 Certified staff present, 1 must be a Supervisor

Disposal Process If a med is refused or accidentally dropped And a Supervisor is unavailable Two Certified staff may dispose of the med following acceptable DPH disposal practices To the Trainer: If your company has a policy that all disposal is to be completed in the presence of a Supervisor make sure your staff know that.

Documentation Required DPH Controlled Substance Disposal Record Form for all prescription medication Schedule II-VI disposals May use for over the counter meds The DPH form is required to be used for countable meds and other prescription meds that are not countable, such as Tegretol and Dilantin. Let staff know if your company also uses the DPH disposal form for over the counter meds.

DPH Disposal Form Documentation of any prescription med disposal is required on a DPH disposal form. If the prescription med is countable there must be a corresponding note in the count book indicating why the med was disposed of.

Disposal Form Scenario 1 Connections 100 North St. MAP05555 1-yr 12/20/yr Joseph Smith 11/22/yr Ativan 0.5mg one tab Dropped on floor D388857 1 11 Cornerstone Reggie Newton Lisa Long Disposal form scenario 1 demonstrates how to completely fill in the first box of a DPH disposal form as if this is the first disposal for the current year. Neither of the 2 staff are supervisors. There must also be corresponding documentation in Count Book 1 on page 11 (that you will see in the next slide). The ITEM # is a sequential numbering of each box each time a med is disposed of for any individual. If you wanted, you could document as Item # 1. In this scenario, the Supervisor chose to include the Item # 1 and the year [Item # 1-2013]. At the end of the year 2013 and the beginning of 2014; the renumbering could begin with Item # 1-2014. Either way is acceptable. On the bottom of the form there is a space to number each disposal page. 1

Count Sheet Scenario 1 Page 11 Scenario 1 demonstrates how to document disposal of a dropped med on the floor in a count book during your shift when there is another MAP certified staff present. This is the corresponding documentation to the disposal form on the previous slide. Note that the Supervisor was notified but the 2 Certified staff disposing of the dropped tab are not supervisors. Karen Mason is the Supervisor. 12/20/yr 8am dropped on floor and disposed of. Karen Mason, Supervisor notified. 6 one dropped 5

Count Sheet Scenario 1a Page 11 Scenario 1a demonstrates how to document that a med was dropped on the floor when you are working alone or without another MAP Certified staff. The med waiting for disposal must be kept on count until it is disposed of. 12/20/yr 8am one tab dropped on floor. In cup in locked box waiting for disposal. Karen Mason, Supervisor notified. 12/20/yr 4p tab dropped at 8a 12/20/yr disposed of- leaves 4 Lisa Long/ Reggie Newton

Count Sheet Scenario 2 Page 11 Count sheet Scenario 2 demonstrates how discontinued countable meds must continue to be kept on count until they are disposed of with 2 staff, 1 of which must be a Supervisor. Karen Mason is the Supervisor. After disposal, Karen would also update the count book index by writing her signature under the column titled “Signature of person responsible for removing medication from count”. 12/19/yr 1:30pm Ativan discontinued at this morning's PCP appointment. Karen Mason, Supervisor notified that med needs to be disposed of. Reggie Newton 12/20/yr 10am Six Ativan tabs discontinued 12/19/yr were disposed of. _______________________________________________ zero Karen Mason/Reggie Newton

Disposal Form Scenario 2 Connections 100 North St. MAP05555 1-yr 12/20/yr Joseph Smith 11/22/yr Ativan 0.5mg six tabs Discontinued D388857 1 11 Cornerstone Reggie Newton Karen Mason Disposal form scenario 2 demonstrates the disposal form of the corresponding documentation in the count book of the previous slide. Karen Mason is the Supervisor. 1

Disposal Form Scenario 3 Connections 100 North St. MAP05555 1-yr 12/20/yr Joseph Smith 11/22/yr Ativan 0.5mg six tabs Discontinued D388857 1 11 Cornerstone Reggie Newton Karen Mason 2-yr Dec. 21, yr Mike Jones Nov. 30, yr Acetaminophen 325mg eighty five tabs expired 123654 Cornerstone Reggie Newton Karen Mason 3-yr Dec. 30, yr Mike Jones July 1, yr OTCs do not require documentation of disposal per DPH but mention here what your company expects. Disposal form scenario 3, Item #2 shows the disposal of expired acetaminophen being done with 2 staff, 1 of which is the Supervisor. OTC meds are not countable, so there is no information that goes in the count book number or page number sections of the form. Disposal form scenario 3, Item #3 shows the disposal of a dropped Tegretol [a prescription med and although not countable, this form is required] being done with 2 staff, neither of which are supervisors. Tegretol 100mg one tab fell on floor 654321 Cornerstone Lisa Long Reggie Newton 1

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