Pharmaceutical Waste Minimization

Why Should Pharmaceutical Waste be Minimized?

Pharmaceutical waste is comprised of many distinct waste streams that reflect the complexity and diversity of the chemicals that compose pharmaceuticals. For example, some pharmaceutical wastes are categorized as regulated medical waste, while others are considered hazardous. A hospital pharmacy generally stocks between 2,000 and 4,000 different items, each of which must be evaluated against state and federal hazardous waste regulations before being thrown away.

The use of pharmaceuticals is consistently increasing, driven by both drug development and an aging population; therefore, the amount of pharmaceutical waste that is generated is also increasing. Pharmaceutical waste may be generated through a variety of activities in a health care facility, including intravenous (IV) preparation; general compounding; spills and breakage; partially used vials, syringes, and IVs; patients’ personal medications; and outdated pharmaceuticals.

To reduce the compliance burden, costs, and risks associated with disposing of this unique waste stream, pharmaceutical waste should be minimized. Several methods that can be used separately or in combination to minimize pharmaceutical waste at your facility are discussed below.

Methods for Minimizing Pharmaceutical Waste

Pharmaceutical waste can be minimized in several ways, including regulating the products that enter your facility and modifying management practices to make better use of pharmaceutical products. In addition, specific types of pharmaceutical waste that are hazardous, such as chemotherapy waste, can be better managed at the point of use to minimize waste. When targeting specific pharmaceutical waste streams for implementing waste reduction practices, consider the volume generated, toxicity of the waste, and existing management practices (centralized or decentralized waste stream) to most efficiently focus your efforts. These considerations will help you target the “low hanging fruits” of this complicated waste stream.

Regulation of Products Entering the Facility

• Purchasing: Implement purchasing practices that minimize waste, such as selecting products with less packaging, selecting products without preservatives, ordering single-dose containers that do not need a preservative, and accepting drugs only if they have an expiration of greater that one year unless they are only available with shorter expiration dates.
• Pharmaceutical Samples: Control pharmaceutical samples to ensure that pharmaceutical representatives are not over-supplying samples and that physicians are providing samples to patients and rotating sample inventory. If particular drug samples are consistently being wasted, determine whether usage patterns have changed for particular drugs. The most restrictive control method would be to not allow samples, while less restrictive methods could limit samples to the top six or ten drugs prescribed at your facility.
• Dosing: Purchase products in the doses that are routinely administered to minimize wasted product. For example, if your facility purchases 100-mg tablets of a medication but only 50 mg are routinely administered, changing purchasing patterns could reduce the amount of waste that is generated.
• Liquid Pharmaceuticals: Purchase oral syringes and bulk liquids rather than prepackaged unit dose liquids to minimize wasted product. With an oral syringe, the exact dose can be dispensed, eliminating waste.

Modification of Management Practices and Better Use of Products

Another way to minimize pharmaceutical waste is to change management practices to make better use of products, as follows:

• Label patient-specific medications used during a hospital stay for home use. With a discharge prescription from the physician and proper outpatient labeling, a patient can take the medication home and finish using the product. If patient-specific medications cannot be sent home with the patient, these medications are returned to the pharmacy for destruction.
• Use oral syringes to dispense specific doses rather than using prepackaged unit dose liquids, which often results in wasted product.
• Monitor expiration dates on syringes and vials on general crash carts, and when they are removed, use these syringes and vials in the Emergency Department or in intensive and/or critical care units. Syringes and vials on general crash carts are typically removed within 3 months prior to outdate. Rather than discarding them, they can be used in other departments in your facility before expiration.
• Implement a strict inventory control program to limit the amount of product that expires before use. Minimizing outdated pharmaceuticals will save resources spent on the management of such products.
• Use a reverse distributor to return expired pharmaceuticals to the manufacturer for credit. It is important that your facility select a reverse distributor that complies with Environmental Protection Agency (EPA) regulations. Using a reverse distributor can help your facility reduce the amount of pharmaceutical waste generated as well as reduce the need to properly categorize, store, manifest, transport, and dispose of pharmaceuticals. Management of Chemotherapy Waste. In managing pharmaceutical waste, it is especially important to properly manage hazardous wastes, including chemotherapy waste. Chemotherapy waste can be minimized through the following methods:
• Use hard plastic buckets rather than brown paper bags to deliver chemotherapy drugs to the appropriate department(s). This will not only reduce waste but also will provide greater spill and leak protection during transport.
• Retain partial chemotherapy vials until they expire for potential use in oncology pharmacies to both reduce waste and save money.
• Prime and flush chemotherapy IVs with saline prior to dispensing and after administration. These practices not only ensure that the patient receives the full dosage and reduce the opportunity for employee exposure but also enable IV bags and tubing to be managed as trace chemotherapy waste.

Tips for Successfully Minimizing Pharmaceutical Waste

To determine what methods your facility should use to minimize pharmaceutical waste, consider the following tips for success:

1. Document current practices. For your facility to effectively minimize pharmaceutical waste, it is important to determine what pharmaceuticals are being wasted, why they are being wasted, and how wasting can be minimized. This information can be used to help your facility determine where to focus its waste minimization efforts.
2. Determine the cost of handling and disposing of pharmaceutical waste. In addition to knowing what wastes are being disposed of, determining the cost of waste segregation and disposal will also help your facility determine where to focus its waste minimization efforts. Included in the cost is the time that it takes for staff to review waste regulations and product expiration dates as well as the disposal fees for various waste streams, including hazardous waste.
3. Communicate with manufacturers. If your facility determines that it could minimize waste if its needs were better met, work with manufacturers to meet these needs. For example, your facility could request that the manufacturer use less packaging for products entering your facility, cover disposal costs of outdated samples, coordinate shipping to return outdated product for credit, or produce doses of medication that are typically administered at your facility (such as making 300-cc bottles of a product if it is currently only available in 50-cc, 250-cc, and 500-cc bottles but your facility routinely uses 300 cc).

Key Resources:

Managing Pharmaceutical Waste: A 10-Step Blueprint for Health Care Facilities in the United States
Practice Greenhealth. April 15, 2006 Presents a number of ways to minimize pharmaceutical waste as well as suggestions on how to implement those methods.

Reducing Pharmaceutical Waste from Patient Care Settings
Minnesota Technical Assistance Program. February, 2007. MnTAP investigates a number of ways to minimize pharmaceutical waste, including stock rotation, minimizing samples, alternative packaging and purchasing and inventory management.

Managing Drug Waste Liabilities
Health Facilities Management. January 15, 2001. Discusses management of pharmaceutical waste in compliance with EPA regulations, including using a reverse distributor to return outdated drugs to manufacturers for credit.

Advice on Selecting a Reverse Distributor
Health Facilities Management. March 7, 2006. Provides guidelines for selecting a reverse distributor that complies with EPA regulations.

Cradle-to-Cradle Stewardship of Drugs for Minimizing Their Environmental Disposition while Promoting Human Health-Part II: Drug Disposal, Waste Reduction, and Future Direction
Environmental Health Perspectives. May 2003. Discusses drug disposal and waste reduction, including the use of reverse distributors (page 776).