| Source Newsletter 2007 issue 1 |
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Rx for the Environment
Hospitals are reporting tenfold increases in costs for managing pharmaceutical waste. Prevention options are helping some facilities reduce drug waste and costs.
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MnTAP intern at the Hennepin County Medical Center, Jonathon Schulz, holds two volume options for glutose gel. |
With the push to manage waste pharmaceuticals in a more environmentally and healthful way, hospitals are reporting tenfold increases in costs for managing pharmaceutical waste. Prevention options are helping some facilities reduce these costs. One pharmaceutical reduction project estimated that the hospital could save a minimum of $23,500 annually if several procedural changes were implemented.
Environmental impact
An increasing number of studies are showing a connection between pharmaceuticals in wastewater and impacts on aquatic life. Concerns have been raised about possible hormone disruption, antibiotic resistance and other effects. Hormones from drugs might be causing male fish to develop female traits and change behaviors in both sexes. Some drugs are also considered acutely hazardous.
Unwanted medication should not be disposed into the sewer system. Technologies used at wastewater treatment plants are not able to remove drug compounds that have entered the sewer system, either through excretion of partially metabolized pharmaceuticals or disposal of unused or expired medications down the drain.
Epinephrine
Epinephrine is a P-listed waste because it is considered acutely hazardous by the U.S. Environmental Protection Agency. Its use can easily cause a health care facility to be deemed a large quantity generator (LQG) of hazardous waste.
LQGs must provide hazardous waste training to all of their staff who come in contact with hazardous materials, including pharmaceuticals. In a hospital that includes nearly everyone except administration. Hazardous waste training is estimated to cost $70 per staff person. Small health care facilities can carefully track their historical epinephrine use and control its waste from surgery to help the facilities avoid becoming LQGs.
Stock rotation. An inventory analysis by a MnTAP intern at Tri-County Hospital in Wadena showed that the facility could reduce the stock of epinephrine on ambulances by six vials. A pharmacy staff member at Tri-County conducts an inventory analysis of all crash carts and stations in rooms housing epinephrine. Short-dated medications are removed and reallocated to areas of high use.
Alternate packaging. Another MnTAP intern discovered that Hennepin County Medical Center (HCMC) used a fraction of the 250 epinephrine intracardiac syringes it
purchased in one year. The only significant difference between the intracardiac syringe and other epinephrine syringes is its 18-gauge, 3.5 inch needle. HCMC was able to substitute a packaged 100 microgram per milliliter (100 mcg/ml) syringe with an 18-gauge needle affixed to the outside of the box. This allows for stock rotation to reduce hazardous waste by 13 pounds per year and dual waste by 7.5 pounds, saving $900 a year.
Purchasing/inventory management
Hospitals should analyze the demand for pharmaceuticals using par usage reports, which computerized inventory systems can easily output. They should see if dosage types are redundant and can be consolidated. The intern at Tri-County Hospital determined that 157 medications were purchased in multiple dosages and three percent of returns through reverse distribution were from formularies with multiple dosages, costing $1,450 annually.
HCMC was purchasing glutose gel in 15-gram (gm) tubes for its crash boxes—used to store drugs for emergency situations—where it often went unused, and using 45-gm tubes in the Omnicells for diabetics. The facility could switch to only purchasing 15 gm tubes and rotate stock from the crash boxes to reduce costs by $345.
Stock rotation. The two facilities identified crash boxes, crash carts and ambulances as locations with the greatest potential for products to expire and become waste. Rather than letting products expire in these areas, both facilities developed plans to bring items that had high use elsewhere back to the pharmacy two to three months prior to expiration for redistribution.
Sample waste. Samples left by pharmaceutical representatives are often short dated or sometimes have expired. During one two-month time frame, HCMC accumulated 35 pounds of sample waste, costing it $520 in disposal and sorting fees.
Because many samples were not being logged, HCMC moved its sample log from the pharmacy to the purchasing department to make it more accessible to visiting pharmaceutical representatives. A new policy was developed making Purchasing responsible for logging samples and only allowing samples with one year or longer for expiration.
See MnTAP’s Pharmacies Web page for links to more information.
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