San Juan Regional Medical Center (SJRMC), a 254-bed acute care hospital located in Farmington, New Mexico, provides a broad range of medical, surgical, and rehabilitation services. In addition to the main hospital, SJRMC has several off-site facilities that offer convenient primary care, specialty care, diagnostic, and rehabilitation services. Due to this broad range of services and locations, SJRMC facilities produce a vast amount of pharmaceutical waste. Managing waste in accordance with both state and federal laws required a systematic approach to identify, handle, and properly dispose of all RCRA-regulated hazardous and non-hazardous pharmaceutical waste.
Our method to ensure that pharmaceutical waste is disposed of via the appropriate waste stream was to locate designated color-coded containers on all nursing units: non-hazardous waste is disposed of in blue containers, hazardous waste in black containers, chemotherapy waste in yellow containers, while aerosols, corrosives, and oxidizers are separated into their own designated waste containers. A medical waste management company periodically removes these containers from the facility and ultimately disposes of them appropriately. However, the company we employ does not dispose of narcotic waste, which created a hole in our pharmaceutical waste process. In the past, narcotics were often wasted via the sink or into sharps containers, and despite knowing this was not the ideal way to handle these products, we struggled to find an appropriate process or product that would meet our narcotic waste needs.
Appropriate Narcotics Disposal
In order to address this deficiency, we chose to implement the Smart Sink from Cactus in May 2013. During our research phase, we found this system to be a simple, safe, and convenient way to properly dispose of wasted narcotics while also mitigating the negative impact of these products on the environment. Furthermore, the system helps prevent drug diversion by securely storing narcotic waste and rendering it unrecoverable.
The Smart Sink is a small container with three openings in the top to dispose of medications: one for solids, one for liquids, and one for patches; the openings are configured so that sharps cannot be placed into the unit. Each opening funnels into a separate cartridge (one for liquid narcotic waste and one for solid narcotic waste), which contain compounds that render the drug unrecoverable and unusable.
The system can be securely mounted to a wall or countertop, and to dispose of a narcotic, the nurse simply drops it into the appropriate opening. When a cartridge is full, has expired, or when the unit is opened, there is an audible alarm and a blinking red light. Also, if the battery is low, the red light blinks periodically alerting staff that a replacement is needed. Customized locks and security keys are supplied with every unit, allowing only authorized personnel to open them.
Despite being easy-to-use and intuitive, we had a Smart Sink representative come on-site to provide hands-on training to the nursing staff before incorporating the device into our workflow. Pharmacy was trained on the cartridge and battery exchange, as it is our responsibility to ensure these are replaced when needed; we have found that, on average, cartridges require changing every three months for the volume of narcotic waste we produce. The used cartridges are stored in a secure area of the pharmacy and are removed for destruction by our reverse distributor. Replacement cartridges are ordered from Cactus through our reverse distributor as needed via e-mail.
Complete Waste Handling
The Smart Sink has provided our facility with the missing piece to our pharmaceutical waste puzzle. To date, we have installed 28 Smart Sinks. For convenience, they are located near medication dispensing cabinets in the medication rooms on each of the nursing units. Feedback from the staff regarding system use has been overwhelmingly positive. The most beneficial aspects of the Smart Sink are its simplicity, security, and the assurance that our narcotic disposal is compliant. Administration and staff are satisfied that we now have the most robust process possible to ensure that all pharmaceutical waste is collected and disposed of appropriately. The Smart Sink has allowed our facility to implement a process that meets state and federal regulations by preventing unauthorized access to wasted drugs while eliminating any negative impact on the environment.
Ernest F. Armenta, RPh, MBA, is the manager of pharmacy services at San Juan Regional Medical Center in Farmington, New Mexico. He received a bachelors degree in pharmacy from the University of New Mexico and a MBA from Regis University.
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