Standard Operating Procedure for Disposal of medicines in homes registered to provide nursing care within NHS Sutton CCG Introduction All health and social care organisations are accountable for ensuring the safe management of medicines that are no longer required. This procedure is intended to encourage good practice in the management of medicines for disposal in homes that are registered to provide nursing care, to ensure that safe and legal practices are adopted and that there are good auditable procedures in place to monitor systems. Organisation within which the SOP applies: All care homes receiving medicines from community pharmacies and/or whose service users are registered with GP practices within NHS Sutton CCG Objectives / Purpose To ensure that the home has a contract with a licensed waste management company To ensure that medicines are quarantined and held for 7 days after a patient has died That medicines for disposal are quarantined away from other medicines To ensure that Controlled Drugs are destroyed legally and safely To provide a clear and auditable process to check these medicines sent for disposal To define accountability and responsibilities of individual members and to ensure practice is in line with the regulatory frameworks Scope This Standard Operating Procedure applies to Managers and Nurses working within Care Homes providing nursing in NHS Sutton CCG who are responsible for medicines Responsibilities Staff working in the areas who have a responsibility the safer management of medicines in care homes within NHS Sutton CCG Related Guidelines and Standing Operational Procedures Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities 2009) Regulation 2010 THE HANDLING OF MEDICINES IN SOCIAL CARE Royal Pharmaceutical Society November 2007 The Health and Social Care Act 2008 (regulated activities) Regulations 2014. Safe Care and treatment. Regulation 12 Review Period November 2018 (or earlier if indicated) Validation process: This guidance has been approved by Sutton and Merton MMC for use in care homes within NHS Sutton Clinical Commissioning Group Author and contributors: Hai To, Care Home Pharmacist, NHS Sutton CCG Acknowledgement: Tania Cook, Specialist Senior Medicines Management Technician Social Care Lead, NHS Nottingham City CCG Date Approved: November 2016 1
Process Actions The situations when medicines might need to be disposed of include: A person s treatment is changed or discontinued the remaining supplies of it should be disposed of safely (with the person s consent) A person transfers to another care service they should take all of their medicines with them, unless they agree to dispose of any that are no longer needed Where a service user has passed away, all the medicines must be quarantined for 7 days before disposal, in case the Coroner s Office should ask for them The medicine reaches its expiry date. Some medicine expiry dates are shortened when the product has been opened and is in use, for example, eye drops. When applicable, this is stated in the product information leaflet (PIL). All homes that are registered for nursing care have in place a contract with a licensed waste management company to remove unwanted medicines. Community Pharmacists are not responsible for removal of medicinal waste from nursing homes. All medicines that are unwanted or expired should be stored separately from the medicines in use and securely locked away, with a sign stating Quarantined medication for disposal-do not use. This includes any medication disposal bins provided by the waste management company. Where a service user has died all the medicines must be quarantined for 7 days before disposal, in case the Coroner s Office should ask for them. Complete a written record to show what and how much has been sent for disposal, including the signature of the person who disposes of the medicine and a responsible witness. This can be a senior carer except for the disposal of Controlled Drugs Disposal of Controlled Drugs must be completed by two nurses using a Controlled Drugs Denaturing Kit following the instructions on the kit whilst wearing protective gloves and a mask if dealing with powder formulations. Records of destruction should be made in both the normal written record and the CD register, showing the date, amount destroyed, how, and the signatures of two responsible nurses from the home. Obtain an adequate number of denaturing kits for use during disposal (suggest to have 1 CD denaturing kit per CD cupboard) Denaturing kits can be purchased from your medicines waste contractor or community pharmacies. The CD denaturing kits, when not being used should be securely locked away. The CDs must be denatured before they are taken away for disposal. Instructions for denaturing the different dosage forms may be provided by the manufacturer of the denaturing kit. If this has not been provided, then refer to appendix 1 for guidance on the methods of destruction/denaturing CDs to ensure the CDs are irretrievable. Obtain the signature of the representative of the waste management company who removes the medicines. Responsible Person Designated Nurse 2
Appendix 1: Methods of denaturing/destruction CDS 1 Dosage form Method of denaturing/destruction Solid dosage forms, e.g. capsules and tablets Grind or crush the solid dose formulation before adding to the CD denaturing kit to ensure that whole tablets or capsules are not retrievable. The use of a small amount of water whilst grinding or crushing may assist in minimising particles of dust being released into the air. Where a CD denaturing kit is not available, an alternative method of denaturing is to crush or grind the solid dose formulation and place it into a small amount of warm, soapy water stirring sufficiently to ensure the drug has been dissolved or dispersed. The resulting mixture may then be poured onto an appropriate amount of suitable product* and added to an appropriate waste disposal bin supplied by the waste contractor. Liquid dosage forms Pour into an appropriately sized CD denaturing kit. Where a CD denaturing kit is not available, an alternative method is to pour the liquid onto an appropriate amount of suitable product* and then to add this to an appropriate waste disposal bin. Ampoules and vials For liquid containing ampoules, open the ampoule and empty the contents into a CD denaturing kit, or dispose of in the same manner as liquid dose formulations above. Dispose of the ampoule as sharps pharmaceutical waste. For powder containing ampoules, open the ampoule and add water to dissolve the powder inside. The resulting mixture can be poured into the CD denaturing kit and the ampoule disposed of as sharps pharmaceutical waste. An alternative but less preferable, disposal method is where the ampoules are crushed with a pestle inside an empty plastic container. Once broken, a small quantity of warm soapy water (for powder ampoules) or suitable product* (for liquid ampoules) is added. If these methods are used, care should be taken to ensure that the glass does not harm the person destroying the CD. The resulting liquid mixture should then be disposed of in a CD denaturing kit or in the bin that is used for disposal of liquid medicines. Patches Aerosol formulations Remove the backing and fold the patch over on itself. Place into a waste disposal bin or a CD denaturing kit. Expel into water and dispose of the resulting liquid in accordance with the guidance above on destroying liquid formulations. If this is not possible because of the nature of the formulation, expel into an absorbent material and dispose of this as pharmaceutical waste. Alternatively consider if it would be safe to open or to otherwise compromise the container to release the Controlled Drug safely. The resulting liquid mixture should then be disposed of in a CD denaturing kit and disposed of as pharmaceutical waste. * A risk assessment should be carried out to determine whether a product is suitable. A suitable product should render the Controlled Drug irretrievable without compromising patient safety, the safety of the person carrying out the destruction, or the environment. 3
Reference: 1. Royal Pharmaceutical Society; Medicines, Ethics and Practice. The professional guide for Pharmacists. Edition 40, July 2016. 4
I have read and understood this standard operating procedure and agree to work to it. Name Job Title Signature Date Home Manager 5