Hospitals continue to demonstrate an increasing commitment to environmentally sound pharmaceutical waste management across all levels of the facility, and it is clear that this commitment is not a passing fad. However, significant roadblocks continue to prevent the adoption of thorough, environmentally sound, compliant practices. 

Survey Design
Given the myriad challenges to compliant pharmaceutical waste management, PP&P polled a random, nationwide sampling of health-system pharmacy directors in the fourth quarter of 2011. We asked about pharmaceutical waste practices, budgets, regulatory compliance and commitment to responsible waste management. Responses were submitted via Email, with pharmacy directors from a total of 419 facilities responding, yielding a confidence interval of 4.61% (95% +/-4.61) based on the total population of pharmacy directors nationwide.

We intentionally surveyed a random sampling of pharmacy directors, not just readers of PP&P, to ensure our data reflects trends across the whole of hospital pharmacy practice. Thus, we were pleased to learn that 75% of pharmacy directors nationwide use PP&P as a resource for information on pharmacy waste management. 

Challenging Waste Practices
While hospital administrations’ stated commitment to compliant practices is strong, when it is not backed up with demonstrable actions, the likelihood of building a successful program quickly diminishes. In space constrained hospital environments, perhaps the strongest statement of support administration can make is to provide adequate space for waste management, along with educational and budget support. Managing waste commitments is much simpler when a line item exists in the budget for these activities.

Most pharmacy directors acknowledge that RCRA-regulated waste remains their biggest challenge in this arena. And while awareness and compliant practices improved somewhat this year, significant education efforts are required to achieve full compliance. Conversely, pharmacy directors declare significant confidence in their management of controlled substances. But a closer examination of actual practices indicate that some of that confidence may be misplaced; fentanyl patches, for example, provide significant challenges, and many facilities continue to dispose of controlled substances via the sewer. Although this last practice may meet the regulatory requirements of some states, it certainly does not qualify as a gold standard of practice.

Now that products and services are being introduced to address many of these challenges, from consultant-based programs to an automated waste sorter and a system for controlled substance containment, it is incumbent upon pharmacists to investigate these options and develop a program that ensures cradle-to-grave responsibility while meeting their facility’s commitment to the community at large.

Getting Started
The inherent challenges resulting from a lack of regulatory direction and conflicting requirements have been widely acknowledged.  While there is hope for an eventual universal waste rule, the current lack of direction is not an excuse for inaction. On the pages of PP&P we regularly share the stories of pharmacy directors who have undertaken programs to manage pharmaceutical waste in their facilities, and while we can expect these programs to evolve as regulations change, it is key that all pharmacy directors are actively developing a plan for their organization. Take advantage of the groundswell of desire by employees throughout the organization to avoid negatively impacting the environment. From nurses who are uncomfortable squirting wasted morphine into the toilet, to pharmacy technicians concerned with creating less chemotherapy waste, staff members by and large are ready to embrace waste management practices that ensure environmental stewardship. 

Pharmacy is in the ideal position to drive the development and implementation of programs that improve the status quo and make it easier for staff to do the right thing.  By embarking on a cradle-to-grave approach, you may not be able to achieve immediate perfection, but every step that increases staff and patient safety, along with environmental stewardship, is a worthwhile investment of your resources.