HANDLING HAZMEDS: Most hazardous medications are disposed of in these red bins.
Certain medications that are beneficial to patients pose potential health risks to employees who may be exposed to them. Under the direction of the Medication Education Safety and Approval Committee, a multidisciplinary team – including Pharmacy Compliance, Patient Care Services, Environmental Health and Safety, Environmental Services, Corporate Compliance, the Practice Support Division, and the Center for Quality and Safety – recently rolled out improvements to the process for handling and disposing of hazardous medications.
“These medication process improvements provide a universal approach to safely handling hazardous drugs in order to protect our employees,” says Meg Clapp, RPh, MS, MDiv, chief pharmacy officer.
New yellow auxiliary labels created by Pharmacy identify which medications are hazardous and both indicate appropriate personal protective equipment requirements and proper waste disposal methods. This information also has been incorporated on patient-specific medication labels as well as in Pharmacy online ordering and automated dispensing machines.
A three-tier approach to personal protective equipment for hazardous medications has been developed based on potential mode of exposure. The requirements are as follows:
• Tier I (intravenous medications): one or two pairs of long-cuffed, purple, nitrile gloves and a non-absorbent, long-sleeved, disposable gown are required. A face shield should be worn if there is a risk of splash. An N-95 respirator must be worn to clean up spills.
• Tier II (oral liquid medications): same requirements as Tier I, but in addition, j-tip connector and blue chux are required for G-tube administration.
• Tier III (solid capsules, tablets, creams, ointments and eye drops): one or two pairs of long-cuffed, purple, nitrile gloves are required (two pairs for ointments, creams, and eye drops). Do not crush, open, or dissolve capsules or tablets.
The proper disposal method is identified by a new color-coded system that provides additional guidance alongside the Pharmaceutical Waste Disposal Grid available on the Environmental Health and Safety website. Per the color-coded system, acetone and arsenic must be disposed of in black buckets, chemotherapy drugs in yellow buckets and nearly all other hazardous medications in red buckets.
Although this change has increased the number of medications that are disposed of in red buckets, limited products can still be disposed of in regular trash or down a sink drain. “Items including IV fluids, plus or minus electrolytes, continuous veno-venous hemofiltration (CVVH) fluid and peritoneal dialysate have been approved for this disposal method as long as they do not contain any medication additives,” says Kelly Barnes, RPh, compliance pharmacist.
It is important to recognize that all used medications must be discarded appropriately, adds Barnes. Medications are considered used if they are opened, are a partial dose or have come in contact with a patient – including those brought into precaution rooms without direct patient contact. Unused medications should always be returned to the Pharmacy for proper disposal.
For more information about hazardous medications, contact Barnes at firstname.lastname@example.org or Bill Banchiere, director of Environmental Services at 617-726-2445.
Read more articles from the 07/13/12 Hotline issue.