Pharmaceutical Waste Program Healthstream for Inpatient Pharmacy

Pharmaceutical Waste Program
Portland Service Area
What is Pharmaceutical Waste?
• Waste that is generated through the preparation and/or
administration of pharmaceutical agents. This includes
partially used vials, syringes, and IV bags; medication
inhalers and aerosols; and discarded medications.
What Happens to Pharmaceutical Waste?
• Currently, nearly all pharmaceutical waste is
disposed in sharps containers and treated similarly
to other forms of waste. Because of this, it ends up in
landfills, rivers, streams, and oceans.
And Then What Happens to It?
• In recent years, pharmaceutical waste has been found in
a wide variety of animal and human food and water
sources. There is mounting concern about the long-term
consequences to our health and the environment .
What is the Solution?
The solution is to separate pharmaceutical waste
from other forms of waste and dispose of it
appropriately. This will help us to:
• Keep pharmaceutical waste out of our groundwater and
landfills and to reduce potential harmful effects to our
• Minimize the risks associated with managing hazardous
• Comply with current and future regulatory requirements
regarding the disposal of pharmaceutical waste
We are part of the solution!
Providence Health and Services has made the decision
that all pharmaceutical waste generated by our facilities
must be discarded in special bins so that we can process
and dispose of it in an environmentally sound fashion.
• How the pharmaceutical waste must be handled
depends upon whether or not it is classified as
hazardous waste.
• Hazardous pharmaceutical waste must be identified and
disposed of separately from all other pharmaceutical
Hazardous Pharmaceutical Waste
• Medications which can pose a substantial hazard to human
health or the environment when not properly managed. These
have been identified by the Environmental Protection Agency
and other environmental health agencies as requiring special
disposal methods
▫ Toxic and flammable chemicals
 This includes all chemotherapeutic agents as well as a small number
of other medications such as: Nicotine, Physostigmine, Warfarin,
Insulin, Metronidazole
▫ Flammable aerosols
 This includes all aerosol inhalers
Non-Hazardous Pharmaceutical Waste
• All other medications are classified as non-hazardous
pharmaceutical waste.
• This does not mean that they are not harmful to the
environment, it simply means that they are not on the list
of medications that are regulated by the Environmental
Protection Agency or are classified as highly toxic.
• This waste will also be disposed of in an environmentally
sound manner.
How does this work?
Providence is utilizing 3 different types of containers to
segregate waste.
• Black Bin (Hazardous pharmaceutical waste)
• Yellow Bin (Trace chemotherapy waste)
• White Bin (All other pharmaceutical waste)
Pharmaceutical waste collection bins will be located in
med rooms and soiled utility rooms
Black Bins for Hazardous Waste
All hazardous waste must be
disposed of in a BLACK bin.
• All vials, IV bags, tablets or patches containing
residual hazardous drugs, including bulk
chemotherapy, must be discarded in a black bin
• Aerosols must be kept separate from all other
hazardous materials and so they will be
disposed of in a special black bin (labeled
• Unused syringes containing hazardous drugs
will also be disposed of in a special black “dual
waste” bin (black sharps container).
Three Special Cases
• 3 hazardous drugs are specially regulated by EPA:
 Warfarin
 Arsenic Trioxide
 Physostigmine
• Empty vials or IV bags previously containing these 3 drugs in
liquid form, must be disposed in black hazardous waste bins.
 Empty wrappers from tablets of these 3 drugs can go in the white bin.
 All other empty drug vials (glass and plastic) are disposed in white nonhazardous bins.
Black Bins for Hazardous Waste
• The good news— Medication requiring black bin
disposal will be noted in the comment field
upon barcode scanning in Horizon Clinical
• Screenshot
Yellow Bins for Trace Chemo
• Trace Chemo Only, including:
▫ Empty vials, tubing, syringes, and iv bags, as well as
gowns, gloves, wipes, and other items contaminated
with trace amounts of chemotherapy drug.
▫ Sharps contaminated with trace chemo
White Bins for Everything Else
1. All other drugs not identified as hazardous.
▫ Including pills, vials and IV bags containing
non-hazardous drugs
▫ Exceptions: Non-med IV fluids (NS, LR,
D5LR, D5NS20K, KCl) are disposed in the
▫ All controlled substances discarded in the
sink (and fentanyl patches go in the red
sharps container) as per current practice.
2. Empty vials (glass and plastic) of hazardous
and non-hazardous drugs
 Exception: put empty containers of Warfarin,
Arsenic Trioxide and Physostigmine in black
hazardous waste bin.
What doesn’t go in a special bin?
• Empty IV bags, tubing, and other types
of packaging without patient identifiers
may be discarded in the trash as per
current practice.
▫ Empty means “empty by normal
means.” A few drops left in a bag or
a few cc’s of medication retained in
the IV tubing is considered empty.
• Empty or partly used syringes should be
placed in the red sharps container as per
current practice.
• IV fluids (NS, LR, D5LR, D5NS20K,
KCl) and All controlled substances will
be discarded in the sink (and fentanyl
patches go in the red sharps container),
as per current practice.
Frequently Asked Questions:
• Why will we continue to dispose of controlled
substances in the sewer?
▫ The DEA requires disposal of controlled
medication in a secure manner.
▫ By removing other hazardous drugs from the
sewer system, we will significantly improve our
current practice.
▫ As environmental regulations evolve, we may find
ways to improve controlled waste disposal
Pharmaceutical Waste and Disposal
Hazardous Drugs,
Bulk Chemo,
& empty vials & IV
bags that contained
Warfarin, Arsenic
Trioxide and
Used or partlyused syringes
and vaccines
UNUSED syringes
hazardous drugs
All other
drugs, &
Identifying Black Bin Drugs
• Medication requiring black bin
disposal will be noted in the
comment field upon barcode
scanning in Horizon Clinical.
• This note will also appear on
the label of patient-specific
medications delivered from
• Screenshot: “black
bin disposal”
Frequently Asked Questions:
• Why is one dosage form of a drug on the list
when another form is not? (for example:
prednisolone ointment is on the hazardous
drugs list but the tablets are not)
▫ Some drugs are regulated because of the
preservatives or additives they contain (mercury,
for example), not because of the toxicity of the
medication itself.
▫ Just because one drug from a particular class is on
the “hazardous” list does not mean all other drugs
in that class are also hazardous.
Frequently Asked Questions:
• Why can’t I throw pills in a sharps container?
▫ Sharps containers are disposed of in the landfill
and hazardous waste needs to be incinerated to
protect the environment.
• How should I carry pills to the white bin?
▫ Carry medication back the way it came (put pills
back in the original package or cup)
Frequently Asked Questions:
• What should I do with sharps or used
syringes containing hazardous drugs?
▫ If the syringe is full and has never been
used (expired drug, for example),
dispose in the black sharps container
located in med room.
▫ If the syringe has been used at all,
dispose in the red sharps container,
even if residual drug remains.
UNUSED syringes
hazardous drugs
USED syringes of
all types
Frequently Asked Questions:
• What should I do with sharps or
used syringes containing
chemotherapy drugs?
• Syringes used for chemo drugs are
disposed of in the yellow trace chemo
bin, as per current practice.
Frequently Asked Questions:
• What should I do with IV bags?
• Empty IV bags can go in the trash, as long as they
don’t have patient identifiers on the label
• If an empty IV bag includes patient identification,
dispose of it in the white bin.
• EXCEPTION: Empty IV bags previously containing
arsenic trioxide (one of the 3 “special drugs”) go in the
black bin.
• IV bags with residual medication go in the black
bin, if the label says “black bin disposal”, or in the
Take home points
• We have made the decision to dispose of our
pharmaceutical waste in an environmentally
sustainable manner.
• All pharmaceutical waste will go in one of three
1. If the EMAR says “Black Bin Disposal” or it’s an
orange-label chemo drug, discard full or partfull containers in a black bin.
2. Trace chemo goes in a yellow bin.
3. Non-hazardous drugs and empty containers go in a
white bin
Take home points
If the EMAR says “Black Bin Disposal”:
Vials and Pills
IV Bags
Full or partly-full
go in black bin
Full or partly-full
go in black bin
Unused & full go
in black sharps
Empty go in white Empty go in trash
(if no patient ID
on label), or white
bin (if patient ID)
Used (empty or
partly empty) go
in red sharps
• All aerosol inhalers go in black bin labeled “aerosol”
• Empty vials or IV bags previously holding liquid warfarin,
arsenic trioxide or physostigmine go in black bins.
Take home points
If it’s a chemo drug:
• Bulk chemo goes in black bin
▫ Including full or part-full vials and iv bags
▫ Also including empty arsenic trioxide iv
Bulk Chemo
• Trace chemo goes in the yellow bin:
▫ Including sharps used for chemo, PPE and
empty containers
▫ “Trace” is defined as “empty by normal
means” and no more than 3% of volume
remaining in the container
Trace Chemo
Take home points
If it’s NOT a hazardous drug:
Vials and Pills
IV Bags
White bin
• Full or partlyfull go in white
• Empty can go in
Red sharps
• Non-med IV liquids go down the drain (including
dextrose, lactated ringer, electrolytes, Ca/K/Mg
• Controlled substances go down the drain (fentanyl
patch down the drain), following usual procedure.
Frequently Asked Questions:
• Where are pharmaceutical waste bins located?
 In med rooms and soiled utility rooms
• Who is responsible for picking up and replacing
full bins?
 Environmental Services
• What happens after the bins are picked up?
 Black bins are shipped to a regulated hazardous
waste incinerator.
 White bins are shipped to a regulated medical waste
 Red sharps containers are autoclaved and disposed
in a landfill.
• See your unit manager for more information

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