January 31, 2008 

Cathy Colglazier 

Public Advocate 

Small Business/Community Support 

Bureau of Enviromnental Field Services 

1000 SW Jackson, Suite 430 

Topeka, KS 66612-1367 

Dear Cathy: 

Pollution Prevention Institute 

133 Word Hall 

Manhattan, KS 66506 -2508 

785-532-6501 foX' 785-532-6952 

800-578-8898 

www.sbeap.org 

Enclosed please find the fourth quarter (final) report and attachments for the Pharmaceutical 

Waste Outreach Project. You should have already received the electronic copy of the report. 

As a one-year pilot, the message to eliminate drain disposal at healthcare facilities attracted a 

lot of attention across the state and nationally. We now have concurrence and have built 

relationships with associated agencies such as the Kansas Department on Aging and the U.S. 

Drug Enforcement Agency. The recently published poster is very popular. Requests for it 

and/or technical assistance come in to our hotline or via our pharmacy Web page almost 

daily. 

The project included 16 on-site facility visits, provided phone and e-mail consultation to 

more than I 00 contacts, and was featured on at least two radio and three television stations. 

It drew 55 pre-registrants for the Webcast and was ranked by pharmacists and licensed 

nursing staff as a very important issue to their profession. 

One hundred percent of the clients worked with through the site visits and presentations 

indicated they would change their behavior as a result of what they had learned through this 

outreach program. One long-term care (LTC) facility indicated it had eliminated 1500 doses 

per month from drain disposal since its on-site consultation last surmner. 

Program staff successfully worked with the Kansas Board of Pharmacy and the U.S. Drug 

Enforcement Agency to clarify legal disposal options for controlled substances, dispelling a 

long-time myth, and eliminating or at least minimizing the most common drain-disposed 

pharmaceuticals (controlled substances and bulk liquids) at LTC facilities. In addition, staff 

learned that a new House bill, HB2578, has been introduced to further optimize take-back 

programs at LTC. 
Althot1gh th~ proj~ct work has technically ended, we'd weleome a4dition funding tlt1d~r 

S:SEAP, or a s~parate contract to support technical assistance, additional W~bcasts, and 

printing anoth~r rotlt1d of posters. 

Thank you for this opportunity. If you have qu~stions or ne<;:d a44itional information, pleasil 

feel free to contact me at 800-578-8898. 

Sincerely, 

Nancy J. Larson, RS 

Director 

Enclosures 
Pharmacy Waste Management Pilot 

Pilot accomplishment summary 

Proposed Task I Milestone I Accomplishment 

Research existing program • Completed Completed and documented in 

successes, waste ·January- initial quarterly reports. 

management tools, and • June 2007 

BMPs. 

. Develop an advisory board Completed Hosted two call meetings, 

made up of agency partners to February- May <!nd November 2007. 

help shape the program. December 

2007 

Research take-back options to Completed Work with Kansas Board of 

. ensure their full potential is February- Pharmacy, pharmacists, and 

· being utilized. December facilities to ensure this priority 

2007 option was fully used. HB 2578 

introduced as part of Webcast. 

Provide on-site technical Completed Completed site visits with 16 

assistance to at least 1 0 February- entities, nine LTC, three 

nursing home facilities. December hospice, three hospital 

2007 pharmacies, and one medical 

clinic. 

Research options for disposal Completed Worked directly with Sedgwick, 

through local HHW or SQG February- Johnson, Wyandotte counties, 

programs. December and two smaller HHWs. Also 

. 2007 worked with poison control. . . ..... 

Develop targeted education Completed Provided comment on BWM 

material - utilize BWM March- Tech Guidance and have widely 

technical guidance document, December distributed the published 

and publish "No flush" poster 2007 document. It is featured on our 

for med room or over the Web page and in several 

hopper. presentations. Poster has been 

widely distributed through 

associations and directly to 

facilities. It has been very 

popular with requests for more 

coming in nearly daily. 

Articles to association Completed Presented at four state 

newsletters and/or speak at March- conferences: two pharmacy 

conferences such as Kansas December conferences, one nurses 

Board of Pharmacists; Kansas 2007 conference, and one healthcare 

Department of Aging; KDHE engineers; articles provided to 

Office of Rural Health; and at least six different association 

Kansas Association of Homes newsletters. News releases 

January 31, 2008 I 

I 
and Services for the Aging. 

I 

published. Two radio and three 

TV interviews completed. 

Work with Kansas Department Completed Kansas Department on Aging 

on Aging to add information as inspectors have posters and 

part of their facility surveys. BWM technical guidance for use 

with their site visits. Offered 

cross-training for inspectors. 

Develop an e-mail distribution Completed More than 1 00 contacts to 

list of nursing home contacts April- hotline and via e-mail as result 

to communicate issues and December of project. 

answer questions. The 2007 

SBEAP hotline will also be 

promoted. 

Develop a pharmacy waste ·Completed Dedicated site developed and 

management Web page at April- posted. These pages recorded 

www.sbeap.org. December a total of 990 visits. 

2007 

· Host kansas-specific and Completed Hosted 90-minute Webcast Dec. 

project-related June- 13, 2007, featured three 

teleconferences for nursing December speakers. More than 55 prehome and pharmacy staff. 2007 registered for event. 

Piggy-back program with other Completed Inventoried for mercury devices 

waste management elements January- during site visits. Identified 501 

. like "Making Medicine • December grams and provided guidance 

Mercury-Free." 2007 for elimination. 

Measure, evaluate, and ·Completed Project worked with more than 

provide quarterly reports and a April- 1 00 contacts via e-mail and 

final report. December hotline; completed 16 site visits; 

2007 hosted Webcast for 55 preregistered participants; identified 

501 grams mercury for removal, 

and documented 1500 

doses/month eliminated from 

drain disposal at one of the 16 

facilities visited on site. 

Develop Phase II project · Pending Response to Webcast, site 

proposal ·approval visits, and continued requests 

• Continue technical from BOW for information are strong 

assistance indicators that the audience 

• Publish more posters needs and wants this water 

• Host additional Webcasts quality education. 

• Utilize a P2 intern 

January 31, 2008 2 
To: Karl Mueldener, KDHE BOW 

From: Nancy Larson, K-State PPI 

Re: Nursing home pharmaceutical outreach program- final report 

Date: January 29, 2008 

The Proper Place for Pharmacy Waste- pharmaceutical outreach project for 

nursing "home" facilities 

Project status: I 00% complete 

Activities by task 

Project planning and research 

First quarter: Project coordinator participated in two Webcasts during fall 2006 in 

preparation for this project. Two main project planoing meetings were held in January. 

The Jan. II, 2007, meeting was held in Topeka with Steve Caspers of BOW, Joe Cronin 

and Maria Morey of BWM, and Lesa Roberts of KDHE. During this meeting, we 

reviewed the project and methodology. Discussion related to appropriateness of the 

target audience was also reviewed, as well as the possibility of doing water quality testing 

on the Wichita basin using KDHE labs in an effort to achieve baseline water quality data. 

A second planoing meeting held Jan. 24, 2007, included Sedgwick County watershed 

partoers Becky Gagnon, Susan Erlenwein, and Carolyn Hosford; as well as KDHE staff 

members Joe Cronin, Cathy Colglazier, and Lesa Roberts. Questions related to water 

quality testing feasibility were discussed but found not practical by KDHE and the city of 

Wichita. Discussion related to target audience showed support for moving forward with 

LTC facilities unless further assessment dictated a change. 

SBEAP staff has met with nursing home long-term care pharmacists, Mike White of 

Omnicare and Debra Billingsley of the Kansas Board of Pharmacy, in an effort to better 

understand issues related to legal options for return and disposal of expired 

pharmaceuticals. 

Second quarter: Research continues as staff discuss and promote program elements with 

Kansas regulators, HHWs, and healthcare facilities, including pharmacists and nursing 

staff. Staff monitor the national pharmacy waste and Hospitals for a Healthy 

Environment (H2E) listserves. 

On May 2, 2007, staff met with KDHE staff to review the progress of the project and 

discuss findings. Based on comments and data, it was recommended staff provide 

technical assistance to healthcare pharmacists beyond just LTC as requested. It was 

discussed that development and use of a poster in LTC may not have the impact 

originally discussed. This deliverable will be reassessed as the project progresses. 

Phannaceutical outreach to nursing homes Final report 
Advisory board 

First quarter: No meetings have been held, but several members have been identified. 

Second quarter: An advisory board meeting was hosted by conference call May 31, 2007. 

The board is made up of 11 members representing various long-term care and pharmacy 

waste interests from Kansas and one national pharmacy representative. The advisory 

board roster and meeting agenda are included as attachments. The meeting served to 

inform stakeholders of the program and some of the barriers healthcare facilities face 

related to finding the proper place for pharmacy waste. The meeting lasted just over one 

hour; minutes from the meeting are attached. 

Third quarter: Follow-up correspondence completed with specific advisory board 

members related to May call discussions and action items. Second advisory board call 

plarmed for November. 

Fourth quarter: Advisory board meeting held Nov. 15,2007. Members were provided 

an update on the project, then details related to the Dec. 13 Webcast. Members offered 

suggestion and assistance with Webcast promotion. Members provided comments 

related to the poster content and art work. Meeting agenda included with attachments. 

Research take-back options 

First quarter: This research has begun with long-term care (LTC) pharmacists, the 

Kansas Board of Pharmacy, calls to local pharmacies, and discussions with one LTC 

facility. Kansas law allows that unused blister-pack medications can be returned to the 

original pharmacy for credit in LTC facilities. Return of these blister-pack medications is 

often left up to the nursing staff. Retail pharmacies called in Wichita included Wal-Mart, 

Dillon's, and Walgreens, all of whom stated they would NOT accept medication returns, 

not even in blister packs. 

Both Ms. Billingsley and Mr. White explained that due to U.S. Drug Enforcement 

Agency (DEA) regulations, controlled substances (scheduled medications) carmot be 

returned and must be destroyed on site at long-term care facilities. Mr. White explained 

that most pharmacists believe the only safe way to destroy these controlled substances is 

through drain disposal. Perception at this time is that any other disposal method, such as 

denaturing and landfilling, carries too much liability for purposeful misuse or accidental 

ingestion. 

Full survey results are enclosed, but based on data taken from a survey of LTC 

pharmacists, pharmaceuticals at LTC facilities are more often drain disposed than 

returned. 

What method of disposal or return is utilized? 

drain disposal- 27 trash- 12 return processors- 14 other- 6 

Pharmaceutical outreach to nursing homes 2 Final report 
Method of disposal 

c Drain disposal 

• Trash 

o Return processors 

0 other 

Second quarter: Optimizing use of take-back programs was discussed in depth with our 

advisory board and is a primary topic when staff provides technical assistance to 

healthcare pharmacists. The Kansas Board of Pharmacy is aware of some of the barriers 

and is working to optimize take-back options for healthcare. 

Third quarter: Have requested the Kansas Board of Pharmacy talk with DEA 

representative and provide further guidance about the legalities of destroying controlled 

substances using non-drain disposal options. 

Fourth quarter: PPI worked directly with Kansas DEA representative, Judy Williams, to 

review the CFR as it relates to return programs and disposal options for controlled 

substances at LTC facilities. Kansas Board of Pharmacy and U.S. DEA confirmed that 

there is no legal option for return of controlled substances, but that nearly all other excess 

and expired pharmaceuticals could be returned if they meet blister-pack and return 

criteria. DEA confirmed that disposal options other than drain disposal are perfectly 

legal for LTC facilities as long as the drugs are rendered unrecoverable. 

House bill 2578, the utilization of unused medication act, would further support takeback programs, especially for LTC facilities. This HB was discussed as part of our 

Webcast. It is also included as an attachment. 

Site visits 

First quarter: One site visit has been completed and the draft site-visit survey document 

developed for use with such is attached. This facility answered most of the questions via 

their facility administrator. This facility indicated it returned 80% of its pharmaceuticals; 

the contract pharmacist destroyed controlled substances on site and other waste, including 

pharmacy waste, was taken to the local HHW facility. 

Second quarter: Two other pharmacy-waste technical assistance site visits were 

requested and completed at hospitals. These two facilities indicated that more than 90% 

of their expired or unused medications were currently being returned through a licensed 

processor. Pharmaceuticals still being drain disposed included partially used chemo and 

epinephrine IV solutions. Staff worked one on one with pharmacists and nursing staff at 

these locations to detail preferred and regulated waste management practices and 

Pharmaceutical outreach to nursing homes 3 Final report 
provided resources, including a copy of "The Blueprint for Pharmacy Waste 

Management" and the HERC guide for pharmacy waste management. Staff worked with 

two other facilities reviewing and providing comments to their written pharmacy waste 

and chemo waste management plans. 

Third quarter: Completed another seven pharmacy-waste, technical assistance site-visit 

consultations. Facilities included four long-term care, one hospice, one hospital, and one 

medical clinic. 

Fourth quarter: Completed a project total of 16 site visits, 12 in Sedgwick County, and 

another four in various Kansas locations. This included nine larger long-term care 

facilities, three of the largest hospice organi:~;ations, three hospitals, and one medical 

clinic. Staff also provided numerous phone consultations and a few presentations via 

conference call to organized groups requesting further technical assistance. 

All facilities except one LTC facility were very corporative and interested in voluntary 

measures to eliminate drain disposal. A summary of site-visit survey results for the most 

pertinent questions follows. 

)> Using a scale from 1 to 10 (1 0 being highest), clients ranked their familiarity with 

environmental impacts related to pharmacy waste disposal practices as a 6. 

)> 100% of clients indicated licensed nursing staff and pharmacists were the 

responsible for disposal of pharmaceuticals. 

)> 100% of clients indicated that either the director of nursing and/or the contract 

pharmacist would be the responsible party for setting disposal policies. 

)> 100% clients indicated they drain-disposed partially used liquid pharmaceuticals 

and controlled substances. 

)> 33% indicated they drain-disposed of other pharmaceutical, even blister packs, 

that may otherwise meet the criteria for returning. Lack of understanding and 

communication with contract pharmacist was noted as the main reason for this 

additional drain disposal of expired or excess pharmaceuticals. 

)> 67% indicated they fully utilized the return program, except when it came to bulk 

liquids and controlled substances. None realized they could use a solidification 

approach and landfill the pharmaceuticals that could not be returned. 

)> 100% of the LTC and hospice facilities visited on site were categorized as small 

quantity generators (SQG). These facilities generate very few, if any, RCRA 

hazardous pharmaceuticals. Other RCRA hazardous waste related to maintenance 

was identified, but only at the SQG level. 

)> A total of 501 grams of patient care-related mercury was identified at three 

Pharmaceutical outreach to nursing homes 4 Final report 
facilities. Information related to elimination and recycling was provided. 

Research disposal options through local HHWs or SQG programs 

First quarter: Nationally, PPI has researched HHW and SQG pharmaceutical collection 

programs, including those in Wisconsin, Florida, and Washington state. Information 

related to the programs in Wisconsin was shared with BWM stafflast winter. Locally, 

PPI has met with Sedgwick County staff who indicate they will continue to take 

pharmaceuticals from both residents and SQGs. PPI has spoken with four other HHW 

programs. Two small programs indicate they will take the waste, and two other larger 

programs, Wyandotte and Johnson counties, indicated they do not want to knowingly 

accept the waste or advertise its acceptance. BWM has indicated they will provide PPI 

with a list of the HHWs that will accept the waste. PPI provided comments to the new 

technical waste management guidance document. 

Second quarter: PPI has provided the new BWM guidance document to several entities 

and encouraged use ofHHWs for pharmacy waste disposal in Sedgwick County. At this 

time, BWM has not established a list ofHHW that will collect pharmacy waste, but staff 

will continue to work with BWM on expanding and promoting disposal options through 

HHW s and SQG programs. A call to the state poison control hotline revealed that hotline 

staff still used to recommend drain disposal, but now have the BWM guidance and will 

provide the information to clients. Administrative pharmacy staff at poison control 

indicated options other than drain disposal are not always feasible and voiced frustrations 

that Johnson and Wyandotte counties HHWs will not accept this waste. 

Third quarter: Met on site with Sedgwick County's new HHW director to confirm and 

coordinate efforts related to collecting pharmacy wastes from qualifying long-term care 

facilities. 

Fourth quarter: Continued to promote use of Sedgwick County SQG program to LTC 

facilities. Provided program brochures during on-site visits and included program contact 

information and location in all reports. Provided HHW program information within 

articles and as part of radio and television interviews. 

Develop targeted education material 

First quarter: PPI provided comments to the new technical waste management guidance 

document. 

Second quarter: Using the new BWM technical guidance document, staff has encouraged 

non-regulated entities to follow the waste management hierarchy and discouraged use of 

the drain-disposal option. BOW and PPI management discussed that development and 

use of a poster in LTC may not have the impact originally discussed. This deliverable 

will be reassessed as the project progresses. During site visits and at presentations, staff 

are utilizing previously developed national pharmacy waste management resources, "The 

Blueprint for Pharmacy Waste Management," and the HERC seven-page guidance on 

pharmacy waste, in addition to BWM technical guidance. 

Pharmaceutical outreach to nursing homes 5 Final repmt 
Third quarter: Continue to assess poster deliverable need and subsequent development as 

technical disposal issues are reviewed. Will discuss deliverable with BOW in October 

during project update meeting. 

Fourth quarter: Determined need for poster at meeting with BOW. Poster was drafted 

and reviewed by BOW, BWM, and other advisory board members. Final product 

published in early December when DEA confirmed legal disposal of controlled 

substances at LTC facilities could include solidification and land-filling. Five hundred 

four-color posters were published, 300 of which were also laminated. To date, nearly 

400 posters have been distributed, with requests for the posters coming in via hotline and 

our Web page several times a week. 

Conference presentations and articles 

First quarter: First-quarter presentations related to this topic were made to a group of 

about 50 LTC pharmacists at their annual state workshop, Feb. 18,2007. As part of the 

presentation, both pre and post tests were given. A swnmary of these survey results and a 

copy of the presentation are enclosed. Highlights from the survey indicated the 

following: 

• About 80% or more of the pharmacists are responsible for disposal of medications. 

• Pharmacists are responsible for determining how expired or excess pharmaceuticals 

are handled 95% of the time. 

• Some of the pharmaceuticals managed are RCRA hazardous- some P-listed or 

acutely hazardous. 

• About 55 %of the pharmacists indicated that nursing staff are responsible for 

disposal or return of non-controlled substances. 

• On a scale from 1 to 10, with 10 as the highest, pharmacists ranked the importance of 

this topic to their profession as a 9. 

When asked what type of changes they might make as a result of what they learned 

during the presentation, the following answers were provided: 

o Changes related to waste management regulatory compliance?- 16 

o Changes to evaluate disposal practices? - 25 

o Review of waste handling practices with nursing staff? - 28 

o Ensure return opportunities are fully utilized?- 18 

o Implement waste minimization practices? - 23 

Pharmaceutical outreach to nursing homes 6 Final report 
Ensure 

return opps 

fully utilized 

Waste 

management 

regulatory 

compliance 

Implement 

wasteminimization 

practices 

Type of changes 

Evaluate 

disposal 

Review of 

wastehandling 

practices w I 

staff 

A second presentation to a group of about 15 was completed at the KDHE WORKS! 

Conference, March 28, 2007. This audience was mainly HHW staff and other interested 

parties. An overview of the project was described, and the new BWM pharmaceutical 

waste management technical guidance document was featured. 

Second quarter: The Proper Place for Pharmacy Waste was featured as a primary or 

secondary topic at three presentation events this quarter. Survey and evaluation data 

from the two large events follow the data collected first quarter. Evaluation surmnaries 

are attached. Pharmacy waste presentations were made to the following groups: 

:» Kansas Healthcare Engineers Association, state conference, April 5, 2007 

:» Sheppard's Senior Center, Sedgwick County education event, April17, 2007 

:» Kansas Pharmacists Association, state conference, April 21, 2007 

Third quarter: Presentation at state Kansas Nurses Association conference planned for 

early October. Articles provided to Kansas Environmental Health Association, Kansas 

Healthcare Engineers Association, Kansas Association of Homes and Services for the 

Aging, and Great Plains Earth Institute. 

Fourth quarter: Presentation at Kansas Nurses Association completed Oct. 4, 2007. 

Response to presentation was excellent with several nurses indicating the importance of 

this information to their profession. The presentation evaluation summary is attached. 

A news release was published and the topic was featured on at least two radio stations 

and on three television stations. Two different articles for KDHE were submitted, as well 

as articles to Kansas Board of Pharmacy, Kansas Pharmacists Association, Kansas 

Association of Homes and Services for the Aging, Kansas Department on Aging, and 

AARP. 

Work with DOA to add pharmacy waste infOrmation to state survey 

Third quarter: Discussions continue through Caryl Gill and other survey program 

managers. PPI has requested to provide a short program resources presentation as part of 

training for surveyors from around the state. 

Pharmaceutical outreach to nursing homes 7 Final rep.ort 
Fourth quarter: Kansas Department on Aging presented as part of our Webcast, 

supporting this effort to eliminate drain disposal practices. DOA has posters and BWM 

guidance and agreed to help distribute posters and BWM technical guidance as part of 

their site surveys. 

E-mail distribution list fOr LTC contacts 

Third quarter: A list of 37 contacts has been assembled and utilized for release of 

information related to program activities and promotion of related pharmacy waste 

management training opportunities like Webcasts. 

Fourth quarter: This e-mail list was used several times to promote Webcast 

participation, posters and other educational tools, as well as related conferences. Articles 

and promotional items were released via this e-mail group list. Many questions came to 

PPI via these e-mails. 

Development of a pharmacv waste Web page at www.sbeap.org 

Third quarter: A separate pharmacy waste management Web page has been developed at 

www.sbeap.org. A copy of the main home page is attached. 

Fourth quarter: Clients used the site to register for the Webcast and then view Webcast 

presentations and related documents. The dedicated Web page at www.sbeap.org has 

been promoted to multiple contacts through newsletters and e-mails. 

Tracking software indicates that the main pharmacy page was used or visited 849 times 

since being posted in September. 161 of those visits were recorded just this month 

(January 2008). The Web cast page was visited or used 141 times, 44 of which were 

recorded this month. This data supports requests for funding to continue this project. 

Host a pharmacv waste teleconference 

Third quarter: This event has been scheduled as a Webcast to be held on Dec. 13, 2007, 

at 9 a.m. Central. The event is being promoted through several SBEAP and pharmacy 

waste program avenues. Attendees can register via the Web site or through a toll-free 

number at 800-578-8898. The call-in number and presentation will be provided to 

registrants prior to the event. No special software or technology will be required to join 

the Webcast. The 60-minute Webcast will provide an overview of the program and 

recommended alternative disposal practices. Featured speakers include the following: 

)- Caryl Gill, Kansas Department on Aging (confirmed) 

)- Debra Billingsley, Board of Pharmacy (invited) 

)- Nancy Larson, K-State PPI 

Fourth quarter: Although we hoped for 50 registrants for the Webcast, we actually 

exceeded this goal and had to add extra phone lines. A total of 55 participants preregistered for the event which featured the following three speakers: 

)- Becky Gagnon-Lewis, city of Wichita 

)- Caryl Gill, Kansas Department on Aging 

)- Nancy Larson, K-State PPI 

Pharmaceutical outreach to nursing homes 8 Final report 
A copy of the Webc()st presentation is included in the attachments. The event drew lots 

of interest from LTC nursing staff, LTC contract pharmacists, and some hospital 

pharmacists. A few technical assistance providers from other states also participated. 

Develop Phase II project proposal 

Fourth quarter: Discussed Phase II possibilities with BOW at an October meeting. PPI 

will be happy to provide a formal proposal if requested. Elements of the proposal would 

include-

)> Continue technical assistance 

)> Publish more posters 

)> Host additional Webcasts 

)> Utilize a P2 intern 

Measures: 

• An attempt to gather and review national and Kansas baseline data- Determined not 

feasible during May 3, 2007, call with BOW. 

• Advisory board participants and calls Two call hosted. May 31, 2007, II members 

invited and 10 members participated. Nov. 15,2007, 12 members invited, six 

attended. 

• Educational materials distributed- So far, 1,165 pieces of educational material have 

been distributed as part of the outreach. 

• Technical assistance requests via hot line or e-mail- more than 100 requests for 

technical assistance have been recorded. 

• On site visits/consultations- Sixteen on site visits or consultations and follow up 

written correspondence were completed. 

• Web site hits- The main pharmacy page was used or visited 849 times since being 

posted in September. 161 of those visits were recorded just this month. The Web 

cast page was visited or used 141 times, 44 of which were recorded this month. This 

data supports requests for funding to continue this project. 

• Articles to newsletters- Submitted more than 10 articles to seven agencies. Many of 

these agencies then published the articles in newsletters reaching several hundred 

recipients. 

• Media features News release published from K-State media relations led to two 

radio interviews and three television interviews. 

• Presentations to related associations promoting the program - Presentations made to 

six related associations or groups, for a total attendance of more than 150 participants. 

• E-mail distribution list participants- Distribution list to 38 participants developed 

and utilized several times to promote pharmacy waste management trainings and 

related events. 

• Webcast/teleconference participants- Fifty-five participants pre-registered for the 

Webcast. 

• Survey data from Kansas Department of Aging if able to add this item to their survey 

procedure- No data collected by DO A. 

Pharmaceutical outreach to nursing homes 9 Final report 
• Pounds/doses ofpharmaceuticals diverted from POTW through other waste 

management options - At least one client reports eliminating 1500 doses of 

pharmaceuticals from drain disposal each month as a result of our on-site assistance. 

• Grams/pounds of mercury eliminated- 50 I grams of mercury identified for 

elimination. 

Problems anticipated or changes needed 

First quarter: 

• Contract was delayed and initiated in late March instead of January 2007. This 

did not delay work start, just charges to the account. 

• Proposed poster for LTC facilities may need to be adjusted due to information 

discovered related to the flushing of controlled substances and dermal patches, 

which instruct pharmacists to "fold and flush." · 

• Should project staff provide compliance assistance related to RCRA hazardous 

waste as a part of this outreach? Many facilities need to dispose ofP- and Ulisted RCRA wastes. 

• Despite regulatory requirements, many hospital pharmacists still flush expired 

medications. 

Third quarter: Delays in promoting some alternative disposal options due to waiting on 

Kansas Board of Pharmacy and U.S. DEA recommendations or approval. 

Attachments 

First quarter: 

• Presentation to long-term care pharmacists 

• Summary of pre- and post-test surveys of LTC pharmacists 

• WORKS! Conference presentation 

• Draft LTC site-visit survey form 

Second quarter 

• Advisory board: members roster, meeting agenda, and minutes 

• Summary of evaluations from Kansas Healthcare Engineers Association State 

Conference 

• Summary of evaluations from Kansas Pharmacist Association State Conference 

Third quarter: 

• Newsletter articles 

Fourth quarter: 

• Advisory board agenda 

• Summary of evaluations from Kansas Nurses Association State Conference 

• Newsletter articles 

• News release 

• Webcast presentation 

• House Bill No. 2578 

• Poster- previously given to BOW, BWM, and other KDHE staff 

Pharmaceutical outreach to nursing homes 10 Final report