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<div class=Section1>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>In one sense you are correct. Some organizations have very
few resources available and thus need to run as “low-budget” of an
operation as possible. The purpose of collecting data is to look at the
bigger picture and develop solutions. What kind of meds are not being
used? Why? What can we do to prevent the situation from occurring?
A good example is the creation of a law in Maine that prohibits the dispensing
of more than a 15 day supply of benzodiazepines or antidepressants for a first
time prescription. This way, if the dose has to be adjusted or the
individual needs to be changed to a different drug, we can prevent an excess
supply of unused drug from sitting in their cabinet. That new law was
justified by data that had been collected. In a sense, the conduction of
take-back programs is a band-aid approach to a bigger problem. Another
example that I saw at our event: we collected a very large amount of nebulizer
solutions. Should an entire box of nebulizer solution be dispensed for a
patient who has an acute respiratory infection? Probably not. Also,
a large amount of stool softener and laxative products were brought to the
event. These products were sold in boxes of 24 and a majority of the
returns had 20 or more remaining in the container. Should these products
be marketed as a one week supply? Probably. These are just some
basic examples of how the data can be useful. <o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-family:"Monotype Corsiva";color:#1F497D'>Jeanie Jaramillo, PharmD<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-family:"Monotype Corsiva";color:#1F497D'>Managing Director, Texas
Panhandle Poison Center<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-family:"Monotype Corsiva";color:#1F497D'>Assistant Professor, Texas
Tech UHSC School of Pharmacy<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-family:"Monotype Corsiva";color:#1F497D'>1501 S. Coulter
St.
<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-family:"Monotype Corsiva";color:#1F497D'>Amarillo, TX 79106<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-family:"Monotype Corsiva";color:#1F497D'>P: (806) 354-1611<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-family:"Monotype Corsiva";color:#1F497D'>C: (806) 672-0833<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-family:"Monotype Corsiva";color:#1F497D'>F: (806) 354-1667<o:p></o:p></span></p>
<p class=MsoNormal style='margin:0in;margin-bottom:.0001pt'><span
style='font-family:"Monotype Corsiva";color:#1F497D'>Cisco IP: 30412<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><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"'> Dennis Lucia
[mailto:djlucia@gw.dec.state.ny.us] <br>
<b>Sent:</b> Friday, January 15, 2010 10:19 AM<br>
<b>To:</b> Ed Gottlieb; Dave Galvin; pharmwaste@lists.dep.state.fl.us;
Jaramillo, Jeanie<br>
<b>Cc:</b> amy_davis@urmc.rochester.edu<br>
<b>Subject:</b> RE: [Pharmwaste] Take-back inventory time requirements<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"'>We are currently
holding collection programs in New York that do not require the
inventory of all the pharms collected at a collection event. All the
drugs must be handed directly over to law enforcement and maintained in their
control from collection to disposal. All the collected drugs are managed
the same way and incinerated at waste to energy facilities. You can
weigh the collection containers individually to determine the weight of drugs
collected or you can use the weight from the disposal facility. In some
cases participants walk in to collection locations and drop off their bag or
box of drugs, in other cases participants drive up and hand their bag or box of
goodies out the window and drive away.<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"'>No reason to make it
any more complicated than this.<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"'>If you can get law
enforcement to volunteer their time, your only cost is for disposal.
Disposal can run from free to up to $500 for a ton of collected pharms
depending on the waste to energy plant used for the disposal.<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"'>Drugs collected
include: controlled, non controlled, over the counter and hazardous waste
pharms.<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"'>Since hazardous
waste pharms are collected the events require that you obtain a variance to
incinerate the collected waste at a non-hazardous waste to energy plant
(collected household hazardous waste must otherwise be disposed of at a permitted
hazardous waste facility)..<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"'>Process:<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"'>Prepare collection
plan - identify date time location, law enforcement, and disposal facility.<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"'> - the
collection plan must be prepared and approved by the NYS Department of
Environmental Conservation to obtain the variance.<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"'> - get
the waste to energy facility and get them a copy of variance.<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"'>Prepare Dept of
Health Bureau of Narcotics request to hold controlled substance collection -
include plan, approvals from NYSDEC and variance.<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"'>When you have the
BNE approval, advertise and hold the collection.<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"'>At the end of 2009
we held 7 collections across NY.<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"'>We collected 2000
pounds and the cost for disposal was less than $1300 for all the events. <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>
</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"'>Dennis J. Lucia,
P.E.<br>
Pollution Prevention Unit<br>
Division of Environmental Permits<br>
New York State Department of Environmental Conservation<br>
625 Broadway 4th Fl.- SW<br>
Albany, NY 12233-1750<br>
(518) 402-9469<br>
Fax (518) 402-9168<br>
<br>
<br>
>>> "Galvin, Dave" <Dave.Galvin@kingcounty.gov>
1/14/2010 2:55 PM >>><br>
Thanks for the real-world examples related to inventorying. As these
experiences demonstrate, it is extremely labor-intensive to inventory
everything that gets turned in, even for relatively small collection events.<br>
<br>
If we are ever to get to the point of having substantial, convenient take-back
options available to the public on an ongoing basis, collecting the tons (not
pounds) of unused medicines that are out there, we need to come to some
agreement about a sampling protocol that will give us statistically-reliable
data without requiring that every bottle and every pill be counted.<br>
<br>
-- Dave Galvin<br>
<br>
__________________________________________________<br>
Dave Galvin o King County Department of Natural Resources and Parks o 130
Nickerson Street, Seattle, WA 98109-1658 o (w) 206-263-3085 o (fax)
206-263-3070 o dave.galvin@kingcounty.gov o Local Hazardous Waste Management
Program in King County o www.govlink.org/hazwaste/ <br>
<br>
-----Original Message-----<br>
From: pharmwaste-bounces@lists.dep.state.fl.us
[mailto:pharmwaste-bounces@lists.dep.state.fl.us] On Behalf Of Jaramillo,
Jeanie<br>
Sent: Thursday, January 14, 2010 11:10 AM<br>
To: 'Ed Gottlieb'; pharmwaste@lists.dep.state.fl.us<br>
Cc: amy_davis@urmc.rochester.edu<br>
Subject: [Pharmwaste] Take-back inventory time requirements<br>
<br>
We painfully counted everything (pill counts, etc. and estimated ml for
liquids). Our event was from 10-2; 296 vehicles came through, 800 pounds
of meds. The Wisconsin folks (Meddropdane.org) had warned us how tedious
and time-prohibitive a complete inventory would be. But, we had 90 pharmacy
student volunteers, so we thought we could do it. We had about 20 pairs
of people completing inventory - one counting, one entering. <br>
Some were only available for a few hours. We did not have enough
computers and it became quicker for some to log on paper. We closed up at
10pm and had about 75 pages of handwritten logs to enter. So, it takes a
lot of time and manpower. <br>
<br>
I recall Matthew Mireles commenting that many programs now inventory samples,
so if you are interested in logging what comes in and you do not have unlimited
resources, you may want to consider logging in the items collected from every
5th vehicle or something similar. I'd like to see the software
application, perhaps through GoToMeeting. Love the bar code scanning feature,
though our collection did not produce as many items with bar codes. We
definitely don't need to be recreating the wheel if it's already out
there. I greatly appreciate the dialog and info-sharing!<br>
<br>
<br>
Jeanie Jaramillo, PharmD<br>
Managing Director, Texas Panhandle Poison Center<br>
Assistant Professor, Texas Tech UHSC School of Pharmacy<br>
1501 S. Coulter
St.
<br>
Amarillo, TX 79106<br>
P: (806) 354-1611<br>
C: (806) 672-0833<br>
F: (806) 354-1667<br>
Cisco IP: 30412<br>
<br>
<br>
<br>
<br>
<br>
<br>
-----Original Message-----<br>
From: Ed Gottlieb [mailto:egottlieb@cityofithaca.org] <br>
Sent: Thursday, January 14, 2010 11:51 AM<br>
To: pharmwaste@lists.dep.state.fl.us; Jaramillo, Jeanie<br>
Cc: amy_davis@urmc.rochester.edu<br>
Subject: Re: [Pharmwaste] Interest in pharm take-back inventory software
application?<br>
<br>
Hi Jeanie & All,<br>
<br>
Though not required in New York, we will do our best to inventory what<br>
comes in at our March 6th collection event. Even with three pharmacists<br>
there is concern that this process will be a bottle neck. <br>
<br>
Thanks to this list serve, Mr. Ko of Returnco has offered to let us use<br>
his software and data base to speed up the inventory process. This is a<br>
test case for the use of his system for this application. Mr. Ko told<br>
me he hopes that his system will be able to help at many other<br>
collection events. Unlike the poison control data base, Returnco's is<br>
specifically geared to do inventory.<br>
<br>
Similar to your primary goal, a staff member/volunteer will begin to<br>
type in the name of the collected product and a list of possible<br>
medications/dosages will appear to pick from. Even better, if the<br>
container has a bar code it can be scanned and be automatically logged. <br>
I have gotten two estimates that about ten percent of what comes in will<br>
have a bar code. <br>
<br>
Returnco's program will not be able to deliver your ideal of having<br>
the application "link" entries that come from one event participant
as<br>
well as a link to other desired information (like survey questionnaire<br>
results.) This information would be great to have, especially for those<br>
setting policy to decrease the over prescribing of medications. <br>
<br>
Ed Gottlieb<br>
Pretreatment Coordinator<br>
IAWTF<br>
525 3rd Street<br>
Ithaca, NY 14850<br>
(607) 273-8381<br>
<br>
<br>
>>> "Jaramillo, Jeanie" <Jeanie.Jaramillo@ttuhsc.edu>
1/13/2010 5:41 PM<br>
>>><br>
Hi Everyone,<br>
<br>
We conducted our first take-back event in September and had created a<br>
basic Access database to inventory all collections. It worked suitably,<br>
but we are wanting to build upon that. We are talking to a software<br>
development vendor about developing an application that would interface<br>
with Micromedex (includes an enormous database of medications). We use<br>
a similar application for our poison control charting. The primary<br>
desired feature is that a staff member/volunteer could begin to type in<br>
the name of the collected product, then click on a button that would<br>
bring up nearest matches within Micromedex. This would allow the<br>
selection of the appropriate product from a list of possibles and once<br>
"clicked on" would complete the field with the full, properly spelled<br>
name of the product. In our poison application, the generic code for<br>
the product (and the poisindex code) are both then "auto-populated". <br>
Ideally, the application would allow us to "link" entries that come
from<br>
one event participant as well as a link to other desired information<br>
(like survey questionnaire results.) I'm going to try to put a<br>
screenshot of our Access database as I envision the new application<br>
would work similarly, but with many features. So, my question is this -<br>
are there any products out there that any of you use for this already? <br>
And, would there be any interest in such a product from any of the rest<br>
of you?<br>
<br>
[cid:image001.jpg@01CA946F.494834B0] <br>
<br>
Jeanie Jaramillo, PharmD<br>
Managing Director, Texas Panhandle Poison Center<br>
Assistant Professor, Texas Tech UHSC School of Pharmacy<br>
1501 S. Coulter St.<br>
Amarillo, TX 79106<br>
P: (806) 354-1611<br>
C: (806) 672-0833<br>
F: (806) 354-1667<br>
Cisco IP: 30412<br>
<br>
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