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Mission for Meds. Improvement in Pharmaceutical Waste Management at the US Army Community of Caserme Ederle in Vicenza, Italy Presented by Edith Lang for Walden University. Mission for Meds. OBJECTIVES - PowerPoint PPT Presentation

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Mission for Meds

Mission for MedsImprovement in Pharmaceutical Waste Management at the US Army Community of Caserme Ederle in Vicenza, Italy

Presented by Edith Lang for Walden UniversityI am Edith Lang, RN, graduate student in the Walden University Public Health program and the Patient Safety Officer for the US Army Health Center, Vicenza. This initiative is for dual purpose, to impact the environment and to impact patient safety.1Mission for MedsOBJECTIVESIncrease the knowledge of adult Caserme Ederle community members regarding the risks of accumulation of medications in the personal environment.Discuss appropriate reasons for medication waste management in conjunction with current pharmacy take-back program. Increase the return rate of unused medications to the US Army Health Center, Vicenza pharmacy for proper disposal.Mission for Meds objectives are 1. increasing your personal knowledge, 2. waste management and pharmacy take-back, and 3. making both of these things happen.

So, what are medications?2What is a Medication? (Meds)Medications include:any prescription drug (Army or Host Nation)store bought or over-the-counter drugherbal supplementdiet supplements including body building agents Vitaminsmedications for pets should also be considered

It is important to note that any of these substances should be left in their original containers in order to identify the contents for the user or other household members.

Original containers will include any prescribing information on how to take the medication, as well as, dosing and warning labels. Expiration dates are also required on most packages in these category of medications. 3History of Risks51% of Worldwide Sales to the USResiduals of medications found in the environmentDirect disposal (sewage or trash)Bodily wasteWater treatment systemsNot all can be removedFederal Policies

The US Geological Survey reports the presents of one or more personal care product or medication chemical in 80% of the 139 streams of 30 states sampled between 1999 to 2000 (Buxton & Kolpin, 2002).

Estimates from 2002 note that 51% of the worlds pharmaceutical sales were in the United States and Canada (Xia, Bhandari, Das & Pillar, 2005).Why does this matter? Where do these meds go?

Some people throw meds into the trash or flush them way in the toilet or sink. Medications found in the trash by children or foraging animals may be ingested and harm the individual.

Medications and byproducts are excreted into the waste system and if meds are flushed into the system in addition to this, waste treatment systems may not have the capability to filter all the chemicals from entering our drinking water system (Snyder, Westerhoff, Yoon, & Sedlak, 2003).

The human or animal effects of such chemicals into the water system is not yet fully known; But we can do our part to assure personal medications are wasted in the most appropriate channels.

Federal Policies which are supported by the Department of Defense include:

DEA classifies controlled substances into five categories (schedules I through V)Schedule I drugs have a high potential for abuse, other schedules have less potential

For more information: DEAswebsite, CFR, Section 1308 Schedules of Controlled Substances at www.deadiversion.usdoj.gov/21cfr/cfr/2108cfrt.htm

EPA manufacuring, monitoring, and guidance

ChemAlliance . Org http://www.chemalliance.org/ give information to the following programs

Toxic Substances Control Act(TSCA)Chemical Facility Anti-Terrorism Standards(CFATS)Environmental Management System(EMS)Leak Detection and Repair(LDAR)Pollution Prevention Act(PPA)Clean Water Act(CWA)Federal Insecticide, Fungicide and Rodenticide Act(FIFRA)Resource Conservation and Recovery Act(RCRA)

4What is the Risk?Risks of accumulation of such products in your home include:Accidental ingestion by children or petsExpired products may have alternative effects or ineffective results when usedDisposal into the water sources through the sink or toiletDisposal into regular waste receptaclesAccidental overdoses and poisonings are a risk for older adults, children, teenagers, and pets (Seebusen & Edwards, 2006).

Multiple doses of the same medication can be confusing and patients have been known to take exponential doses of a medication in error.

Excess drugs are also tempting for illegal use through theft (Ruhoy & Daughton, 2007).

The disposal of medications into the water sources has been identified as an environmental risk due to residual elements which lead to exposure of humans, animals, and plant life (EPA, 2008).

Medications which are tossed into receptacles for waste are likely to expose animals which forage or children at play (Daughton, 2003). 5Cycle of ExposureHere is a diagram of the exposures to the environment through disposal.

Proper disposal to the Department of Defense Pharmacy can divert accidental overdose in the home, adverse reactions to expired medications, exposure to the community in the trash or water system.6Hazardous Waste Collection & Federal Programs

The US Army Health Center in Vicenza is supported by the Department of Defense to assist in safe and fiscal management of unused pharmaceuticals. This program is managed by the US Army Materiel Management Center in Europe. Once meds are collected from the pharmacy location, they are placed in the proper receptacle and brought here until removed for incineration.

The EPA promotes a guaranteed return program for addressing reverse medication distribution and regulatory environmental issues (EPA, 2008).7Mission for Meds:Do the Right ThingUSAMMCE:United States Army Materiel Management Center, EuropeSince 1995GoalsNo ChargeBenefits

The program supported by USAMMCE has been in place since 1995.

One of the goals for this program is to earn credit by returning medications which have expired. Our suppliers have agreements with the government in this case and money can be saved by earning credit through this program.

The USAMMCE does not charge to support this service.

Other benefits include environmental management and proper handling of medications in our personal possession.

(US Army Materiel Management Center, Europe, 2009)

8What should I do?Assess your home for:Unused medicationsExpired medicationsUnwanted medicationsTake-em-BackKeep medications in their original containerTAKE any unused, expired, or unwanted medication BACK to the Pharmacy at the US Army Health Center, Vicenza.Unused medication which you will no longer need or have an excess supply of including wrong dose of current prescriptions.

Expired medications if no date is present, then bring to pharmacy for assessment.

Unwanted medications drugs that you are not taking but you were prescribed. This is important to communicate to your provider because other treatment options may be available to you if you do not want to take a medication.

Labels may become illegible which can lead to dosing errors.

Always secure your medication in a place which is out of reach to children and animals. 9US Army Health Center, Vicenza bldg 113

Take-Back Pharmacy The pharmacy on Caserme Ederle is located in the health center building 113

Hours of operation are from 0800 to 1700 Monday through FridaySaturday from 0900 to 1300 hrs

11Hours of Operation

Although the doors are locked at 1630, if you are in the building the pharmacy is available until 1700.12Other assistance regarding medication safetyAlso consider contacting (DSN numbers)Army Community Service (ACS) 634-7500Family Advocacy Program (FAP) 634-7489Community Health Nurse 634-8010Child and Youth Services (CYS) 634-7206Patient Safety Officer 634-7952Your medical provider634-7484

13ReferencesBuxton, T., & Kolpin, D. (2002, June). USGS Fact Sheet FS-027-02: Pharmaceuticals, Hormones, and Other Organic Wastewater Contaminants in U.S. Streams. Retrieved April 14, 2009, from http://toxics.usgs.gov/pubs/FS-027-02/

Daughton, Christian G. (2003, May). Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. II. Drug disposal, waste reduction, and future directions. Environmental Health Perspectives, 111(5). Retrieved April 1, 2009, from http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1241488&blobtype=pdf

EPA. (2009). Pharmaceuticals and personal care products in water. Retrieved April 13, 2009, from http://epa.gov/waterscience/ppcp/

EPA. (2008, February). Drug disposal: ramifications for the environment and human health. Retrieved April 13, 2009, from http://www.epa.gov/ppcp/projects/disposal.html

Still working on notes to the slides. Potential references included. 14References ContinuedMackridge, A., & Marriott, J. (2007). Returned medicines: waste or a wasted opportunity? Journal of Public Health, 29(3), 258-262. Retrieved April 1, 2009, from http://jpubhealth.oxfordjournals.org/cgi/content/full/29/3/258

Ruhoy, I., & Daughton, C. (2007). Types and quantities of leftover drugs entering the environment via disposal to sewage - revealed by coroner records. Science of the Total Environment, 388(1-3), 137-148. Retrieved April 13, 2009, from http://www.epa.gov/nerlesd1/bios/daughton/SOTE2007.pdf

Seebusen, D., & Edwards, J. (2006). Patient practices and beliefs concerning disposal of medications. Journal of the American Board of Family Medicine, 19(6), 542-547). Retrieved April 1, 2009, from http://www.jabfm.org/cgi/reprint/19/6/542

Snyder, S., Westerhoff, P., Yoon, Y., & Sedlak, D. (2003). Pharmaceuticals, personal care products, and endocrine disruptors in water: implications for the water industry