10 Steps to Develop and Implement a Pharmaceutical Waste Management Program

Step 5. Minimizing Pharmaceutical Waste

The first step is to ask the following questions:

• What pharmaceuticals are being "wasted?"
• Why are they being wasted? and
• How can wasting be minimized?

The remainder of this step has the following sections that should be reviewed:

1. Considering Lifecycle Impacts in the Purchasing Process
2. Maximizing the Use of Opened Chemotherapy Vials
3. Implementing a Samples Policy
4. Labeling Drugs for Home Use
5. Priming and Flushing IV Lines with Saline Solution
6. Examining the Size of Containers Relative to Use
7. Replacing Prepackaged Unit Dose Liquids with Patient-Specific Oral syringes
8. Controlled Substances
9. Delivering Chemotherapy Drugs
10. Monitoring Dating on Emergency Syringes
11. Reviewing Inventory Controls to Minimize Outdates

Note: A new Appendix C presents two case studies on first-ever documentation of pharmaceutical waste minimization and significant cost savings.

For the complete document, go to:
http://www.hercenter.org/hazmat/tenstepblueprint.pdf

News

FDA Allowing Compounders to Repackage, Combine Propofol Amid COVID-19
After allowing compounders and outsourcing facilities to compound 13 drugs needed to treat patients on ventilators during the coronavirus disease (COVID-19) public health emergency, the FDA says it will also allow compounders to repackage or combine propofol to meet hospitals' needs.
https://www.raps.org/news-and-articles/news-articles/2020/4/fda-allows-compounders-to-repackage-combine-propof

FDA Issues Two "Temporary Policies" (Guidance for Industry, April 2020) for Pharmaceutical Compounding

503a Pharmacies: Temporary Policy for Compounding of Certain Drugs for Hospitalized Patients by Pharmacy Compounders not Registered as Outsourcing Facilities During the COVID-19 Public Health Emergency
https://www.fda.gov/media/137125/download

503b Pharmacies: Temporary Policy for Compounding of Certain Drugs for Hospitalized Patients by Outsourcing Facilities During the COVID-19 Public Health Emergency
https://www.fda.gov/media/137031/download

The Top 20 Pharma Companies by 2019 Revenue
The top pharma companies know how to adapt through M&A, selloffs, cost cuts, and therapeutic rejigs. The companies on this list may have the same names as when they entered 2019, but many have changed internally. The top 20 pharma companies by 2019 revenue are as follows:

https://www.fiercepharma.com/special-report/top-20-pharma-companies-by-2019-revenue

Q&A on an Upcoming Article in IJPC

"Wound Care: Burn Healing, Part 1 (Mike Riepl)"

How can a burn caused by scalding or sunburn cause an infection if the skin is not broken?
Regardless of whether injured skin remains intact, scalding and sunburn produce changes in the immune response at the burn site as well as systemic immunosuppression, both of which increase the risk of infection. The innate and adaptive branches of the systemic immune system are impaired after thermal injury in adult and pediatric patients. All arms of the immune system are involved in burn-associated immunosuppression, during which neutrophilic chemotaxis, lymphokine production by macrophages, natural killer cell activity, the number of T-lymphocytic helper cells, and both phagocytic and bactericidal activity are reduced and the number of T-lymphocytic suppressor cells is increased. Evidence indicates that immune function in burn patients can be restored (and, by extension, the risk of infection reduced) only by means of intensive support such as increased nutrition and fluid resuscitation.

When should propylene glycol not be added to a compounded burn-care base?
If a burn involves >20% of the patient's total skin-surface area, an increase in the absorption of propylene glycol (PG) can occur. PG induces a mild, subacute toxic reaction in healthy human renal cells at concentrations below the serum concentrations often observed in PG-intoxication studies. This toxicity causes a decrease in thymidine incorporation into human deoxyribonucleic acid, mitochondrial metabolic activity, and the cellular viability of proximal renal tubular cells.

Because so many types of commercially manufactured dressings are available to treat burns, do compounding opportunities for customized burn-care bandages exist?
Yes! Commercially available burn dressings cannot provide bandages customized to the degree required to enable the healing of many types of challenging burn wounds, including those in patients with a comorbid condition. For example, studies have shown that phenytoin, misoprostol, and insulin have been effective in healing in patients with diabetes. As was mentioned in answer # 2 above, ingredients such as propylene glycol should not be used to treat burns in infants and in patients with renal, hepatic, or alcohol-dehydrogenase-enzyme-system impairment. Compounded burn-care bandages can also be prepared to include unique combinations of antimicrobial agents (e.g., bacitracin, neomycin, silver sulfadiazine, mafenide) applied in ointment, cream, or gel form that exert antioxidant, antimicrobial, and anti-inflammatory effects to improve tissue healing and prevent infection.

Did You Know ...

...that Will Rogers said the following?

"An economist's guess is liable to be as good as anybody else's."

Tip of the Week

It's interesting that in our society today there are certain professions from which we expect the truth and those that we just listen to their words not knowing with any assurance they are correct. In the first case, we can include healthcare practitioners, manufacturers, construction personnel and engineers, accountants, etc. In the second case, we include the press, talking heads/opinion leaders, meteorologists, politicians, and others.

It's also interesting that in Congress, if an individual under oath and testifying lies, that person can be sent to prison. However, the same people in the room can lie, misrepresent the truth, exaggerate, etc., and they seem to get by with it? Why is this allowed to happen?

When passing legislation/laws of the land, these important discussions and the final documents should be based on the truth! I'm afraid that many laws are passed in Congress based on lies and misrepresentations.

Oh, if we could only get rid of the lies of the press and in Congress, we might be able to learn what is really going on and get real, honest legislation! Maybe Congress needs to be sworn in at each session to "tell the truth, the whole truth, and nothing but the truth." It might also be of interest if we had a requirement that a senator or a representative, when leaving Congress, could only have the same financial status as when they entered Congress.

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Looking Back

Darling, I am
Growing old.
Nonsense! Do
As you're told--get!
     Burma-Shave