Reducing pharmaceutical waste from patient care settings
Scientists are detecting concentrations of
pharmaceuticals in streams and rivers across the
nation, according to the U.S. Geological Survey.
Epinephrine is a commonly used drug. It is
This is due in part to pharmaceuticals entering
found on crash carts and used in many surgical
the sewer system, through excretion of partially
applications. Waste epinephrine can contribute
metabolized pharmaceuticals and disposal of
signiﬁ cantly to a facility’s disposal costs.
unused or expired medications down the drain.
Little is known about the potential health effects
Pharmacy technicians at Tri-County Hospital
to humans or aquatic organisms exposed to
and Hennepin County Medical Center (HCMC)
low levels of these chemicals or their mixtures.
conduct an inventory analysis of all crash carts
Concerns have been raised about possible
and stations in rooms housing epinephrine.
hormone disruption, antibiotic resistance, and
other effects. Studies are being conducted.
Additionally, an inventory analysis by a MnTAP
Drains and toilets became a dumping ground
intern at Tri-County Hospital in Wadena showed
for medications at health care facilities
that the facility could reduce the stock on
ambulances by six vials of epinephrine and 15
vials of lidocaine, both key hazardous wastes for
treat pharmaceutical waste, nor can they
effectively or economically be designed now
to remove these chemicals from our water.
Regulations give guidance to proper disposal
A MnTAP intern discovered that HCMC used
methods. Consult your sewer authority and
a fraction of the 250 epinephrine intracardiac
your hazardous waste regulatory staff before
syringes purchased in one year. The only
signiﬁ cant difference of the intracardiac syringe
from other epinephrine syringes is its 18-gauge,
3.5 inch needle. HCMC substituted a packaged
100 microgram per milliliter (mcg/ml) syringe
with an 18-gauge needle afﬁ xed to the outside of
• Dispose of unwanted or expired medication
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.
Incineration is only legal at permitted facilities.
Minnesota health care facilities, that did not
have permits, have received large ﬁ nes for
Epinephrine is used in operating rooms to
minimize bleeding from cateractectomies,
are reporting 10-fold increases in costs for
managing pharmaceutical waste. A hospital with
reduce epinephrine waste associated with these
over 600 beds is spending about $400,000 a year
procedures, minimize the container size used for
for hazardous waste disposal, which includes
its pharmaceutical waste. The best management
practice is to minimize the amount of unwanted,
lidocaine/epinephrine mixture in a 3cc syringe
as a local anesthetic in the ﬁ eld rather than
MnTAP has a variety of technical assistance services available to help Minnesota businesses implement industry-tailored solutions that maximize resource efﬁ ciency, prevent pollution,
increase energy efﬁ ciency, and reduce costs. 2008 MnTAP. Reprint only with permission from MnTAP. Available in alternative formats upon request. Printed on recycled paper containing
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solution. This ensures aseptic technique
motivated to reduce their returns. Doing
have a clearly deﬁ ned disposal plan for
research. Investigational drugs left over
from clinical trials may require disposal
for diabetics. The facility’s diabetics
When a hospital patient’s care changes,
however, some facilities are not tapping
track historical use and wastes, compile
U.S. Streams fact sheet <http://toxics.
locations with the greatest potential for
Health care facilities should sort their
ﬂ oor, both facilities developed plans
Initiative, February 2005 < http://www.
redistribution through the pharmacy.
reverse distributors are accepting fewer
LUIGI CHERUBINI LIBRETTO ATTO PRIMO Presso la reggia di Creonte, in vista del mare, a Corinto. Ancorata al fondo è la nave Argo. Introduzione Glauce, le Ancelle 1ª Ancella Quando già corona Amor i vostri sospir, su gli occhi ancor vi sta sì profonda tristezza? Su, venite a gioir della nostra allegrezza: il cielo a voi darà i dolci suoi favori. 2ª Ancell
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