STANDARD OPERATING PROCEDURE Title: Procedure Document Version RECYCLING AND DISPOSAL OF MEDICATION ON No: Replaced: WARDS/DEPARTMENTS 20 N/A 2 Procedure Written By: Procedure Approved By: Approved Review Page: Sarah-Louise Walton Gurj Bhella, Date: Date: 1 of 3 01/09/2017 01/09/2019 Pharmacy Technician Chief Pharmacist

Objective: To provide a standard procedure for the recycling of unused medication and the disposal of medicines across all BCPFT Hospital sites.

Scope:

All Black Country Partnership Foundation Trust (BCPFT) Pharmacy staff

Medicines no longer required which have been dispensed by the SLA Pharmacy provider and transferred with the patient, not leaving hospital premises, and still in date, may be recycled.

Any medicines that are no longer required and cannot be recycled MUST be disposed of in the appropriate pharmacy waste bin – (Please see the Trust’s up to date waste policy for the appropriate coloured lidded bin. Appendix A is a list of Hazardous medicines that extra care is needed with).

This includes Patient’s Own Drugs (PODs) only after completion of Patients Own Medicines Destruction Consent Form. See Standard Operating Procedure No.2 – Procedure using Patients own Drugs.

Procedure:

1. At each trolley/caddy check, medicines no longer required which have been supplied by BCPFT, must be removed from either the patient caddy or the medicines trolley. If this medication has not left the hospital premises and been supplied by the SLA Pharmacy Provider, it may be recycled for use by another patient, if found in suitable condition. Check that the medication is in date and suitable for use. Put into pharmacy pre-integrity checking box/drawer in pharmacy for later use and do not remove the dispensed label.

The box/drawer containing the drugs for recycling in pharmacy needs to be emptied on a regular basis. Each medicine needs to be integrity checked by a band 5 technician or above (checking the medicine is in date and establishing its safety and suitability for re-use).

Once the integrity check has been completed the medicine can then be placed into the post integrity checked receptacle/drawer and the medicines can then be accessed by the band 3 pharmacy assistant and booked into the folder and secured in the medicine cupboards for future use.

STANDARD OPERATING PROCEDURE Title: Procedure Document Version RECYCLING AND DISPOSAL OF MEDICATION ON No: Replaced: WARDS/DEPARTMENT 20 N/A 2 Procedure Written By: Procedure Approved By: Approved Review Page: Sarah-Louise Walton Gurj Bhella, Date: Date: 2 of 3 01/09/2017 01/09/2019 Pharmacy Technician Chief Pharmacist

2. Enter the following details in the Stock Control folder on the appropriate alphabetised sheet:-

 Date  The ward the medicine has been returned from (if available)  Drug name (including strength and form)  Quantity  Batch number and expiry date

3. After booking in, store the medication in alphabetical order in the cupboard (all medication must be stored in the lockable medicine cupboard and not left in the office). Medicines must be used in date order.

4. When re-issuing medication, find the correct entry in the Stock Control folder and book out the item by completing the ‘Date and issued to’ box on the log sheet.

5. If and when this item of medication is required for use for another patient or for ward use then apply a new label over the old label before issuing to the ward (apply new label without covering the name and address of original provider)

6. Any out of date medicines, medicines not suitable for use and PODs no longer required by the patient should be disposed of on the wards/department by placing in their original packaging into the appropriate pharmacy waste bin.

7. Make sure hazardous medicines go into the appropriate waste bin.

8. Patient’s own medication no longer required may be disposed of after completion of Disposal of Patient’s own Medicines Form (Refer to Sop No 2 Procedure using Patients Own Drugs). The completed form must then be filed in the patient’s notes, or in the pharmacy if notes have been filed.

9. At the end of each month the costing for all medicines recycled needs to be totalled. This establishes the savings the pharmacy department have made. Working through the recycling folder a list can be made of each medication recycled and the quantity recycled.

10. Once the list of names of medication and quantities have been logged down on a piece of paper somewhere then you need to access the Drug Tariff on line.

STANDARD OPERATING PROCEDURE Title: Procedure Document Version RECYCLING AND DISPOSAL OF MEDICATION ON No: Replaced: WARDS/DEPARTMENT 20 N/A 2 Procedure Written By: Procedure Approved By: Approved Review Page: Sarah-Louise Walton Gurj Bhella, Date: Date: 3 of 3 01/09/2017 01/09/2019 Pharmacy Technician Chief Pharmacist

To access the Drug Tariff online you need to open the following link http://www.nhsbsa.nhs.uk/PrescriptionServices/4940.aspx and scroll down to the appropriate month. Open up the Adobe PDF file and on the left hand side of page and scroll down to the link Part VIIIA Basic Prices of Drugs. Expand the link. Once the page has opened scroll down to your required medication – the price quoted will be for an original pack size – so take precaution to work out the sum if a part pack was recycled. For example – Lansoprazole 30mg for a pack of 28 is £3.48 so if 21 was recycled you would use the sum 3.48 ÷ 28 = 0.124 x 21 = £2.60

Appendix A. Taken from the Safe Management of Healthcare Waste Version 1 www.dh.gov.uk This list is not exhaustive and may not include all very new, unlicensed or trial medicines List of Hazardous medicines.

Aldesleukin Dactinomycin Alemtuzumab Danazol Alitretinoin Daunorubicin Hcl Altretamine Dasatinib Amsacrine Denileukin Anastrazole Dienestrol Arsenic trioxide Diethylstilbestrol Asparaginase Dinoprostone Azacitidine Dithranol Azathioprine Docetaxel Bacillus Calmette-Guerin Vaccine Doxorubicin Bexarotene Dutasteride Bicalutamide Epirubicin Bleomycin Ergometrine/methylergometrine Bortezomib Estradiol Busulfan Estramustine phosphate sodium Capecitabine Estrogen-progestin combinations Carboplatin Estrogens, conjugated Carmustine Estrogens, esterified Cetuximab Estrone Cetrorelix Acetate Estropipate Chlorambucil Etoposide Chloramphenicol Exemestane Chlormethine hydrochloride Finasteride Choriogonadotropin alfa Floxuridine Cidofovir Fludarabine Coal tar containing preps Fluorouracil Cisplatin Fluoxymesterone Cladribine Flutamide Colchicine Fulvestrant Ciclosporin Ganciclovir Cyclophosphamide Ganirelix acetate Cytarabine Gemcitabine Dacarbazine Gemtuzumab ozogamicin Goserelin Hydroxcarbamide

Cont…….

Ibritumomab tiuxetan Raloxifene Idarubicin Raltitrexed Ifosfamide Ribavirin Imatinib mesilate Rituximab Interferon containing products (including peginterferon) Sirolimus Irinotecan HCL Streptozocin Leflunomide Tacrolimus Letrozole Tamoxifen Leuprorelin acetate Temozolomide Lomustine Teniposide Megestrol Testolacton Menotropins Testosterone Mercaptopurine Thalidomide Melphalan Tioguanine Methotrexate Thiotepa Methyltestosterone Toremifene citrate Mifepristone Topotecan Mitomycin Tositumomab Mitotane Tretinoin Mitoxantrone HCL Trifluridine Mycophenolate mofetil Trimetrexate glucuronate Nafarelin Triptorelin Nilutamide Uramustine Oestrogen containing products Valganciclovir Oxaliplatin Valrubicin Oxytocin Vidarabine Paclitaxel Vinblastine sulphate Pegaspargase Vincristine sulphate Pentamidine isethionate Vindesine Pentostatin Vinorelbine tartrate Perphosphamide Zidovudine Pipobroman Piritrexim isethionate Plicamycin Podoflilox Podophyllum resin Prednimustine Procarbazine Progesterone Progestins