With the “green” label becoming ubiquitous in our society, from municipalities’ banning plastic shopping bags to $108,000 Tango electric sports cars, we wanted to examine pharmacy's interest, commitment, and approaches to environmental management...

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We were interested in learning how hospital pharmacies can make a genuine impact on the environment.

Survey Methods
In the second quarter of 2008, PP&P polled a random, nationwide sampling of health-system pharmacists. Responses were solicited via mail and e-mail, and a total of 203 were received, yielding a confidence interval of 6.74% (95% +/- 6.74%) based on the total population of pharmacy directors nationwide.

Pharmacy’s Commitment
Pharmacy is reporting a very strong commitment to environmental management, which holds true across hospitals of all sizes. Furthermore, this commitment is a long-term one, as all hospitals, regardless of size, predict strong and steady growth in
their commitment to environmental management.

Recycling Growth
When it comes to recycling, there is more good news to report. A majority of facilities have recycling programs in place, and these programs are more likely to be organization-wide rather than department-specific. However, many hospitals still have a way to go, with the smallest hospitals facing the longest road: 31% of all hospitals are without any type of recycling program, and for hospitals with fewer than 100 beds, that number climbs to 40%.

There is also opportunity to develop more sophisticated recycling programs. Most programs are managed in-house and very few tie either incentives or disincentives to their programs. Profitability is another area for opportunity. While a majority reports that their programs are revenue-neutral, a significant minority (20%) reports that their programs are cost centers, and only 5% run profitable recycling programs. It is heartening to see that pharmacy’s commitment to environmental management is so high, despite the small number of profitable programs. Low-hanging fruit, such as paper, cardboard, and PCs, are the most commonly recycled items, though efforts are also reported for recycling batteries, aluminum, glass, and packing material. Only 30% of facilities currently mandate participation in their programs. It will be interesting to watch how this percentage changes over time.

Regulatory Compliance in Pharmaceutical Waste Management
Recycling is often thought of at the forefront of environmental stewardship. However, there are many other areas to consider when taking a green approach to your pharmacy, for example: reducing the amount of waste sent down the drain, instituting DEHP-free and PVC-free purchasing policies, and ensuring full compliance with the EPA’s RCRA regulations.

When it comes to meeting the myriad of regulations that affect pharmaceutical waste management (including EPA, DOT, DEA, and state regulations) pharmacy recognizes there is a long way to go. Reflecting the challenge of complying with complex and often conflicting regulations, less than half of facilities report that they are fully compliant with most regulations. However, pharmacies also report plans to put significant effort into regulatory compliance over the next two years. For example, 83% of facilities expect to have achieved full compliance with EPA regulations within the next two years.

Achieving full compliance is clearly challenging, yet very pressing. A majority of facilities report having created a list of all the hazardous pharmaceutical waste in their facilities, however, not all of these facilities included off-formulary drugs in the review, and even fewer included drugs from all departments, such as radiology and nuclear medicine. Because the majority of regulatory inspections include inquiries about hazardous drug waste, achieving full regulatory compliance is imperative. We expect to see this interest from regulators increase, as sources tell us that the EPA is planning to expand their hospital inspection program.

Reducing pharmaceutical waste through tight inventory management is a clear first step toward environmental stewardship. Managing the remaining waste with the least impact on the environment is the next step. Point-of-generation segregation is currently the most common method for managing regulated waste and this approach is predicted to remain so. Interest is high in computer-based automation systems and we expect to see their use in managing regulated waste increase significantly over the next few years. There is good news to report in the projected methods for managing non-regulated waste as the use of regulated medical waste incinerators is predicted to grow, while the use of landfills, sanitary sewer, and municipal incinerators are expected to decline.

Conclusion
Often the impact we, as individuals, can have on the environment can seem miniscule against a challenge so daunting. However, hospital pharmacists are in a key position to make a positive impact through purchasing choices and waste management efforts.
Look for continuing guidance on implementing environmental programs in pharmacy on the pages of PP&P in the months to come. Just as you are committing to environmental stewardship, we are committed to bringing you expert advice on implementing environmentally sound programs, while sharing the success stories of your peers whose efforts have resulted in genuine change.

May the small steps of individuals create the change that is needed in the world,

Deanne Halvorsen
Editorial Director