1. Nurse’s Pharmaceutical Waste Compliance Program
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Nursing Education and Research
Protecting People Reducing Risk

2. Pharmaceutical Waste Why Do We Care About It?
To comply with Federal, State and Local laws & regulations
To comply with The Joint Commission standards
To protect patients & staff
To protect the environment

3. Objectives:
Given pharmaceutical waste guidelines, nursing staff will be able to:
Recognize pharmaceuticals identified as hazardous materials at Palmetto Health
Select the appropriate container for specified pharmaceutical waste
IAW guidelines.

4. Regulatory Requirements
Agencies involved in Rx waste regulation:
Environment Protection Agency (EPA)
Resource Conservation and Recovery Act (RCRA)
Department of Transportation (DOT)
Drug Enforcement Administration (DEA)
Publicly Owned Treatment Works (POTW)
The Joint Commission (TJC)

5. What is Pharmaceutical Waste?
Pharmaceutical waste is a drug that is:
No longer used for its intended purpose
To be discarded

6. Examples of Pharmaceutical Waste
Types of Pharmaceutical Waste in Patient Care Areas:
Partial vials
Partial IVs
Partial syringes
Discontinued medicines
Unadministered medicines
Patient prescriptions

7. Pharmaceutical waste is a drug that is no longer used for its intended purpose and is to be discarded. A)
True B)
False
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8. Hazardous Versus Non-Hazardous Pharmaceutical Waste
EPA Resource Conservation & Recovery Act (RCRA), 1976
Commercial Chemical (Listed) Hazardous Waste
P Listed - Acutely Hazardous
U Listed - Toxic (Chemo)
Characteristic Hazardous Waste
Toxic, Ignitable, Corrosive, Reactive
Non-Hazardous Waste

9. Not all medications are considered hazardous. 
The medications that this compliance applies to will be marked with a code. It applies to about 200 of the medications given at PHR. The codes will be labeled on the med packet, EMAR, and pyxis.  The containers will also be labeled with the same codes.
  If a medication does not have a code, treat it as normal. 
If it has a code, compare it to the codes on the containers and place it in that container.

10. Healthcare Waste Streams
These waste streams stay the same.
Trace Chemo
Bulk Chemo
Controlled Substances
What is different? Pharmaceutical Waste
Only when there is medication left in a vial, syringe, ampoule or IV bag, pills and capsules included
Today your hospital waste stream looks like the top portion of this slide. You have red bags, reusable sharps containers, bulk chemotherapy and trace chemo therapy. You also have Controlled substances. For the record, our program does not address controlled substances because the DEA trumps all other agencies at this point in time. Please continue to follow your hospital protocol with respect to Controlled substances.
Now lets focus on what’s different. Only when there is medication left in a vial, syringe, ampoule or IV bag do you have to be concerned with which container to discard it in. 93% of all pharma waste is non hazardous and is discarded in our blue container. All other pharma wastes are Hazardous and need further segregation into a black or purple container. Just so you are all aware, our bio systems technician will manage these containers inside your hospital just as they do for the current reusable sharps program.

11. Types of Pharmaceutical Waste
Characteristic Hazardous
Lantus
Humalog
Humulin N&R
Novalog
Flovent
Taxol
P – Listed
Epinephrine*
Nicotine Patches
Coumadin/Warfarin
U – Listed
Chemotherapy drugs
Cytoxan
Mutamycin
* State Specific
Dual Waste –
Hazardous
Regulated medical waste with RCRA
(Resource Conservation and Recovery Act)
hazardous drug
Live vaccine
Non Compatible
Unused Silver Nitrate
In- Compatibles
Identified by NDC’s
Aerosols
Cysteine HCL
Glycopyrrolate
Sporanox

12. Which of the following are pharmaceutical waste you are likely to find in patient care areas?
Unadministered medications. B)
Partial vials of medications. C)
Partial bags of IV fluids. D)
All of the above.
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13. RCRA (Resource Conservation and Recovery Act)
EPA RCRA Trace, Empty and Bulk
RCRA (Resource Conservation and Recovery Act)
RCRA Empty - Both conditions must be met:
All contents removed via commonly employed practices (pouring, pumping, aspirating)
Less than 3% of original weight by capacity if the container is less than or equal to 110 gal
So what does this mean to me?
Only hazardous drugs (they will be coded) that aren’t empty need to go in a special container. All other drugs can be wasted as usual except for anything pertaining to coumadin and nicotene (including packaging). These two must be wasted in the approved container.

14. Which of the following statements are true regarding disposal of pharmaceutical waste?
A container is considered empty when all contents have been removed and less than 3% of the volume is left. B)
The procedure for wasting a narcotic has changed according to the pharmaceutical waste guidelines. C)
An empty container is disposed of in regular trash, unless it is coumadin or nicotene. D)
A & C only. E)
A,B & C.
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15. What Does Not Change
Controlled Substances – Follow your hospital’s written policy.
Empty Items – Empty IVs, vials and syringes will continue to be disposed of according to current procedures. except coumadin & nicotine (treat empty containers as hazardous)
Sugar/Salt water IVs – Can still go down the drain: saline, glucose, dextrose, electrolytes, and lactated ringer’s (No Medications Instilled)

16. Satellite Accumulation Containers
Color-Coded Containers for Partial/Full Meds
Compatible Hazardous (Black Container)
In- Compatible Hazardous (Black Container based on code)
Units send back to pharmacy in baggie/tray unless a container is available)
Blue Rx container is for compatible waste, (93-98%)
Purple is for dual waste container. Usually a 2 gallon wall unit in med room and/or soiled utility room.
Black non compatible hazardous waste is found in specialty areas such as pharmacy and OR

17. What Drug Goes Where?
Sort codes will be utilized to emphasize proper segregation for approximately 200 hazardous drugs. Non-coded items go into a non-hazardous container.
Nurses will be alerted by:
Waste Code NotificationOptions
Rx Patient Label
Dispensing machine (Pyxis)
Cubies marked in (Pyxis) medication dispenser
for Coumadin and Nicotine Patches
Patient Record Sheet (MAR)
Black Dots on shelving to signify “hazardous” in
IV area
Container Posters

18. Waste Sort Codes
BKC = Black Compatible Hazardous Container
Example: Humalog
SP = Black In-Compatible Hazardous Container
Aerosols and inhalers
SPC = Black In-Compatible Hazardous Container (may be in OR or ED)
Glycopyrrolate
SPO = Black In-Compatible Hazardous Container (may be in OR or ED)
Unused Silver Nitrate Stick`
PBKC = Package captured in Black Compatible Container
Coumadin/Warfarin and Nicotine
When you see “SP”, think “Send back to Pharmacy”
The medications that are hazardous will have one of these codes

19. Compatible and Non-Compatible Hazardous Waste Container
Oxidizer In-Compatible
Silver Nitrate Sticks
Cyanide Antidote Kit
(SPO) back to pharmacy
Corrosive Non-Compatible
Glycopyrrolate
Selenious Acid
(SPC) back to pharmacy
Compatible Hazardous
Majority of hazardous waste
(BKC)
What Does Not Go In the Container
Controlled Substances
Aerosols/inhalers (SP code) will be returned to Pharmacy.
In-Compatible hazardous waste containers are in the pharmacy
and specialized areas such As OR and ED.
Units send back to pharmacy in baggie/tray unless a container is available)
2 and 8 gallon
These are examples of non compatible drugs found in the Pharmacy, OR and ER

20. 2 Gallon Black Sharps Container
What Goes In the Black Sharps Container
Syringes and ampules with bulk
pharmaceuticals that have not come into
direct patient contact, (infectious) and
are not a controlled substance.
2 gallon
1-3 % of waste in a syringe with or without a needle.

21. Match the pharmaceuticals on the right to the appropriate container on the left.
Column 2
Column 1 C
1.Black 8 gal. non- sharp hazardous container. A.
Syringe used to administer a demerol injection. A
2.Regular red sharps container. B.
Expired vial of Humalog Insulin. B
3.Black 2 gallon sharps container C.
The majority of compatible hazardous waste
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22. Hazardous Storage Area (CAA)
Environmental Services transfers full RX containers to CAA (Central Accumulation Area - Hazardous waste storage area), replaces container in SAA (Satellite Accumulation Area) with empty.
Nurses Action: Contact environmental Services when the containers are becoming full – Do not let containers overflow.
During my survey, I’ll be asking to see your existing CAA to ensure that it is capable of staging and storing all of your Hazardous wastes. NonRCRA blue containers will not be staged in this area. You can utilize your existing RMW/Bio Systems area for the staging of this waste. Bio Systems technicians will be responsible to collect and stage all containers in their appropriate staging area. Please note, if an adequate CAA area is not arranged in time for install and training dates, we will be required to postpone all activity until the area is identified and workable.

23. RX Waste Compliance Program
Conclusion
Recognize pharmaceuticals identified as hazardous materials at Palmetto Health
Select the appropriate container for specified pharmaceutical waste

24. Summary RX Waste Compliance Program
Pertains to non-reusable, partial/full pharmaceutical waste only
Waste medication to be identified by black dots and/or sort codes on:
Rx Patient Label
Dispensing machine (Pyxis)
Cubies marked in (Pyxis) medication dispenser
for Coumadin and Nicotine Patches
Patient Record Sheet (MAR)
Black Dots on shelving to signify “hazardous” in IV area
Sort codes: BLK, SP, SPC, SPO, PBKC will indicate which container the nurse should put the med in. If there is no code it goes in a regular container.

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