GREEN CROSS HEALTH. Submission Covering Pharmaceutical Waste Management - Prepared 25th February 2016

Transcription

1 GREEN CROSS HEALTH 25th February 2016 Submission Covering Pharmaceutical Waste Management - Prepared 25th February 2016 To the Health Select Committee This submission has been prepared by Alison VanWyk, Executive Green Cross Health on behalf of over 300 Community Pharmacies under the Unichem and Life pharmacy brands throughout New Zealand. I would be available and willing to verbally address the Health Select Committee regarding this submission. I can be contacted on alison.vanwyk@greencrosshealth.co.nz or telephone or at Green Cross Health, Private Bag , Ellerslie, Auckland 1542 Background on Green Cross Health Green Cross Health is a listed primary healthcare provider, delivering integrated healthcare solutions in communities the length and breadth of New Zealand. Representing around 338 community pharmacies and 46 medical centers, the organisation also provides specialist nursing senices in the community and home health care senices to more than 23,000 clients in their own homes. Overview of this Submission This submission covers a number of critical elements around the appropriate management of Pharmaceutical Waste within New Zealand as follows: 1. There is no consistent national approach to managing Pharmaceutical Waste within New Zealand. This has led to a lack of consistent messaging across the country with different handling of medicine waste, including sharps(needles), glass and the more complicated controlled drugs and cytotoxics. This leads to Unichem" Uk,CS Phone Fax Ground Floor, Building B, Millennium Centre, 602 Great South Road, Ellerslie, Auckland Private Bag 11906, Ellerslie, Auckland 1542

2 21 Page unsafe practices that affect our communities, healthcare professionals, providers of waste collection and the environment. 2. There is very little community awareness of the need to dispose of pharmaceutical waste appropriately and safely due to the different and inconsistent management throughout New Zealand. 3. Clinical evidence referenced within this submission will provide support of the need to develop a nationally consistent pharmaceutical waste management solution coupled with consistent messaging to consumers and healthcare professionals. Addressing the key points By way of this submission we would like to encourage you to consider the need to develop a national policy and guidelines around the management of pharmaceutical and medical waste. The current lack of a policy or guidelines to manage this would indicate unsafe practices by consumers in disposing of unused pharmaceuticals including needles, glass, controlled drugs and cytotoxic medicines. This could cause harm to those most vulnerable within our communities, due to medicines then being stored within a home environment under unsafe conditions. This could lead to misuse of drugs and the potential for poisoning and needlestick injuries due to unsecure storage. While Community Pharmacists do encourage their communities to dispose of their unused medicines and medical waste appropriately and responsibly, the lack of consistent DHB funding to support waste management has seen pharmacies funding this personally or charging consumers a small contribution to the costs associated with waste management. In some cases, this is seen as a barrier by consumers to returning their unused waste. While Pharmac has previously commented that waste management is the responsibility of the DHBs there is still a lack of consistent policy, action and guidelines to support this. The other key point is the lack of a nationally consistent message to communities around the need to take a responsible approach to managing pharmaceutical and medical waste and the dangers this presents for them, their family/whanau and the environment. Without a nationally consistent policy it is not possible to deliver a consistent national message to consumers so they are aware of the dangers and impact of inappropriate management of pharmaceutical and medical waste.

3 31Page Feedback from community pharmacies would indicate the way in which unused pharmaceuticals and medical waste is transported and handed to community pharmacy for disposal represents a major health and safety concern, with paper bags in some cases being used to transport this waste. If this is left inadvertently in a public place by consumers the risks are significant. Also the receiving of this does represent a risk to the pharmacy team. The consumer is also returning sharps, cytotoxic and controlled drug waste combined in one receptacle. Due to health and safety concerns Community Pharmacists cannot separate out this waste and this is again posing a significant risk as it cannot all be combined into one collection device for providers to remove. As we see the increase in the desire of health to be delivered closer to the home, that we strongly support and with more services and care being delivered in the community the increase in medical waste and unused pharmaceuticals is set to pose an even greater risk. A study published in September 2011 in the JOURNAL OF PRIMARY HEALTH CARE, Disposal practices for unused medications in New Zealand community pharmacies by Alfred YC Tong BPharm;1 Barrie M Peake PhD;2 Rhiannon Braund PhD1, noted that New Zealand Class B controlled drugs have been detected in sewage effluent and surface waters in other countries, and thus further research is needed to determine whether legally binding practices of destroying controlled drugs in community pharmacies are likely to lead to unacceptable levels of these drugs in the New Zealand environment 1 This study also highlighted the need for greater environmental awareness around the disposal of pharmaceutical and medical waste. Not only is there a need for a nationally consistent policy and guidelines on the safe disposal of pharmaceutical and medical waste, there is a need to publicise this to ensure that health professionals and consumers are aware of the need to follow this. As previously mentioned there is significant risk with cytotoxic drugs, such as chemotherapy agents that need to be handled separately. Due to the lack of local incineration facilities these drugs are sent off shore by providers for destruction but they need to be collected in a separate receptacle. There is a significant cost to community pharmacy in the collection and destruction of this stock. There is a significant amount of international evidence that highlights the impact of improper practices around pharmaceutical waste management and New Zealand needs to ensure we follow best practice and the quality use of medicines philosophy to minimise risk and harm that the incorrect disposal of pharmaceutical and medical waste can lead to.

4 4 1Page Recommendations l. That a national policy and guideline is developed for the appropriate collection, containment and disposal of pharmaceutical and medical waste for New Zealand. 2. That a consistent funding model is developed for the appropriate collection, containment and disposal of pharmaceutical and medical waste for New Zealand. Each DHB will have a management and funding policy for their hospitals and this should be extended to primary care consistently. 3. A national campaign around the importance and the "How To" of pharmaceutical and medical waste to consumers and healthcare professionals is developed and launched, highlighting the environmental impacts. For health literacy purposes it should be developed in the key languages with a simplified non-complex message that all our communities can understand. 4. Best practice needs to be taken into consideration, utilising internationals and local practices to inform, develop and implement a national policy. We thank you for the opportunity to make the above recommendation and for your time to review this submission. The health and safety aspects associated with the appropriate management of pharmaceutical and medical waste should be paramount and the true cost of inappropriate waste management considered at all levels. Ultimately the safety of our communities, environment and health professionals should be the key factors that the committee considers. Please do not hesitate to contact me should you require further information or clarification. I do hope that I will be given the opportunity to talk to this submission. Yours Sincerely, ALISON VAN WYK Executive - Professional Services

5 51 Page References: 1 Alfred YC Tong BPharm;1 Barrie M Peake PhD;2 Rhiannon Braund PhDl, Disposal practices for unused medications in New Zealand community pharmacies, VOLUME 3 NUMBER 3 SEPTEMBER 2011 JOURNAL OF PRIMARY HEALTH CARE