The importance of taking a cradle-to-grave approach to pharmaceutical management in hospital pharmacy cannot be understated. When it comes to hazardous drugs, this approach is particularly important to ensuring the safety not only of patients and the staff members working with these drugs, but also for the environment and the public at large. We have seen pharmacy’s increasing involvement in ensuring safety with hazardous products as more closed system transfer devices are used and more facilities are aware of the need to compound hazardous drugs in a chemo hood in a negative pressure cleanroom, venting outside. This month’s issue of PP&P includes the State of Pharmacy Compounding report which details current practices in compounding nationwide, including approaches to managing hazardous products.

Current Disposal Methods
Results from PP&P’s national Going Green survey outline the current methods in use for disposing of waste from used nicotine and fentanyl patches.

Disposal Guidelines
Survey results have shown that disposal practices for nicotine patches vary widely among many institutions. Currently there are no federal regulations requiring a specific disposal method, although some states (including California and Minnesota) have implemented waste regulations for used patches. The impact of these products on the environment should be considered when establishing disposal guidelines for your facility. Because so much of the active drug remains in a used patch, consider managing these products as hazardous waste. “From an environmental stewardship perspective, used nicotine patches should be folded in half to cover the surface that was exposed to the skin, and disposed of in a RCRA-hazardous container,” recommends Charlotte Smith, RPh, MS, HEM, director of PharmEcology Services, WM Healthcare Solutions. “Patches should not be bloody, therefore there is no reason to dispose of them as biohazardous waste.” The waste disposal plan should also include the product’s original packaging. “Labeling the pharmacy shelves to denote hazardous drugs is an efficient approach for alerting staff to manage the packaging appropriately,” suggests Smith.

Disposal Guidelines
Once a fentanyl patch is used, it is no longer in the hospital’s DEA controlled substance inventory, hence double witnessing and documenting of disposal is not required. However, disposing of these patches in the regular trash is an open invitation to diverters and flushing it down the toilet could result in a clog. “The ideal way to dispose of fentanyl patches is to fold them over onto themselves and discard in a container with a counter-balanced lid that restricts entry to prevent retrieval,” says Smith. “A non-hazardous pharmaceutical waste collector is the best disposal option. The disposal can then be managed at a regulated medical waste incinerator.”

Deanne Halvorsen is the editorial director for Pharmacy Purchasing & Products.