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<p class=MsoNormal><span style='color:black'>Practice Greenhealth has been
offering compliance and best management guidance on pharmaceuticals in health
care. Check out our webinar archives over the past few years for a
variety of educational events. The last one was held on May 15 and
included an update on the Blue print guidance document co written by Charlotte
Smith and Eydie Pines, a case study by Albany Medical Center, report out by US
Geological Survey and Stericycle with options/support.<o:p></o:p></span></p>
<p class=MsoNormal><span style='color:black'>Here is a link to the archives <o:p></o:p></span></p>
<p class=MsoNormal><span style='color:black'><a
href="http://www.practicegreenhealth.org/tools/webinars/archive/">http://www.practicegreenhealth.org/tools/webinars/archive/</a><o:p></o:p></span></p>
<p class=MsoNormal><span style='color:black'>Here is a link to the guidance
document:<o:p></o:p></span></p>
<p class=MsoNormal><span style='color:black'><a
href="http://cms.h2e-online.org/ee/hazmat/hazmatconcern/pharma/">http://cms.h2e-online.org/ee/hazmat/hazmatconcern/pharma/</a><o:p></o:p></span></p>
<p class=MsoNormal><span style='color:black'>The Joint Commission has also
added language specific to the management of pharmaceuticals:<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt;text-autospace:none'><b><span
style='font-size:11.0pt;font-family:Helvetica-Bold'>Standard MM.01.01.03 - </span></b><span
style='font-size:11.0pt;font-family:"Helvetica","sans-serif"'>The organization<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt;text-autospace:none'><span
style='font-size:11.0pt;font-family:"Helvetica","sans-serif"'>safely manages
high-alert and hazardous<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt;text-autospace:none'><span
style='font-size:11.0pt;font-family:"Helvetica","sans-serif"'>medications.<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt;text-autospace:none'><b><span
style='font-size:11.0pt;font-family:Helvetica-Bold'>(EP 4) </span></b><span
style='font-size:11.0pt;font-family:"Helvetica","sans-serif"'>The hospital
minimizes risks associated with managing<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Helvetica","sans-serif"'>hazardous
medications.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Helvetica","sans-serif"'>This
is in addition to the Environment of Care Standards for Hazardous Materials an
d Waste that is already in place. The formulary should be in place as
part of OSHA’s Hazard Communication Standard already.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Helvetica","sans-serif"'>I
agree with you, though, that most hospitals still do not have compliant
programs in place. But of the hospitals that we work with (about 700) –
management of pharmaceuticals IS on their radar. The challenge is the
complexity of the regs, not only on a federal level but state to state and the
high cost of the best management approach (antibiotics and such) and dual
wastes. Check out the archives for some examples of the varying ways
hospitals are collecting pharmaceuticals. Some collect all meds and have
them sorted at the back end, while others use a labeling system and segregate
the Ps and Us and characteristic meds in a black bin and the nonregulated
pharmaceuticals in a blue bin, that goes to a regulated medical waste
incinerator, at a cheaper rate than the hazardous waste incinerator. The
bulk chemo goes to a haz waste incinerator, while the trace goes to a regulated
incinerator. Duel wastes (both haz & regulated) go to the incinerator
that is licensed to handle both. And the DOT governs all of this as well.
Some are addressing the acutely toxic drugs as a phase one and then moving on
to other drugs from there. The case studies both from Albany Med and the
Minnesota Technical Assistance Program (another archived webinar) speak to the
financial incentive of pollution prevention through close scrutiny of the
wasted or returned meds to change work practices, purchasing, unit dose etc..
to make less waste.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Helvetica","sans-serif"'>I
don’t have the answers to all of your questions but I hope this helps a
little bit. Please check out both the blueprint and the archived webinars
for more details.</span><span style='color:black'><o:p></o:p></span></p>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'>Janet
Brown<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'>Director,
Sustainable Operations<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'>Practice
Greenhealth <o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'>Po Box
3366<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'>Amherst,
MA 01004<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'>866/598-2110<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'>413/253-0254<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'>jbrown@practicegreenhealth.org<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'>www.practicegreenhealth.org<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><o:p> </o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'>Janet
is on the steering committee of the Green Guide for Health Care.
www.gghc.org. <o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:black'><o:p> </o:p></span></p>
</div>
<p class=MsoNormal><span style='color:black'><o:p> </o:p></span></p>
<div>
<div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><b><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>
pharmwaste-bounces@lists.dep.state.fl.us
[mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b>On Behalf Of </b>William
More<br>
<b>Sent:</b> Monday, June 22, 2009 10:58 AM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> [Pharmwaste] Re: Pharmwaste Digest, Vol 44, Issue 12<o:p></o:p></span></p>
</div>
</div>
<p class=MsoNormal><o:p> </o:p></p>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>So what <u>is</u>
the present compliance rate with our Hospitals Pharmacies with the RCRA -
Hazardous waste regulations? <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>How are they
achieving Hazardous Waste Determinations? How do they segregate wastes, and
when?<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>How many have a
program that know where the stuff that the reverse distributors don't want to
take go? What happens to the waste - contaminated packaging - that comes
from dispensing drugs that can be a "P" waste? Do the
reverse distributors(RDs) tell the hospitals about these materials? Do they,
the RDs, take these back?<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Does that make them
a TSDF? Are they manifested? What mechanisms are the Hospital
Pharmacies using to recover these materials from the patient floors?<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>What are the RDs
doing with those materials that are never credited? The partials that can't be
reused because that are not factory sealed? Those materials that are <u>so</u>
far out of date? The RDs know what they are. Do they pick them up anyway.
Does that make them a TSDF? Are they manifested?<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Have all of the
Hospital Pharmacies had their Formulary,(likely stocked Drugs), reviewed as to
which ones can be a Hazardous Waste when unusable ,unreturnable, un credited,
when a waste. Have they looked for characteristic Hazardous Waste? Mercury compounds
that may be used as a preservative? Metals in vitamins or dietary supplements?
Alcohol or CFCs in inhalers?<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>What are we seeing
when we look at these questions???????<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
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