January 31, 2008
Cathy Colglazier Public Advocate Small Business/Community Support Bureau ofEnviromnental 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 ofthe report. As a one-yearpilot, the message to eliminate drain disposal at healthcare facilities attracted a lot ofattention across the state and nationally. We nowhave 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 ourhotline 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 I00 contacts, and was featured on at leasttwo radio and three television stations. Itdrew 55 pre-registrants for the Webcast and was ranked by pharmacists and licensed nursing staffas a very important issue to theirprofession. One hundred percent ofthe clients worked with through the site visits and presentations indicated they would change theirbehavior as a result ofwhat they had learned through this outreach program. One long-term care (LTC) facility indicated ithad eliminated 1500 doses permonth from drain disposal since its on-site consultation last surmner. Program staffsuccessfully worked with the Kansas Board ofPharmacy 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 thata new House bill, HB2578, has been introducedto further optimize take-back programs at LTC.Althot1gh**th~ proj~ct**  workhas technically ended, we'd weleome a4dition funding**tlt1d~r** S:SEAP, or a**s~parate** contractto support technical assistance, additional**W~bcasts,** and printing**anoth~r** rotlt1d ofposters. Thankyou for this opportunity. Ifyou have**qu~stions** orne<;:d a44itional information, pleasil feel free to contact

## me at 800-578-8898.
Sincerely,

Nancy J. Larson, RS Director EnclosuresPharmacy 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. managementtools, 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 theirfull potential is February- Pharmacy, pharmacists, and

· being utilized. December facilities to ensure this priority 2007 option was fully used. HB 2578 introduced as part ofWebcast. 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 ofAging; 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 

# Iand 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 oftheir 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- 100 contacts via e-mail and final report. December hotline; completed 16 site visits; 2007 hosted Webcastfor 55 preregistered participants; identified 501 grams mercury for removal, and documented 1500 doses/month eliminated from drain disposal at one ofthe 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 2To: Karl Mueldener, KDHE BOW From: Nancy Larson, K-State PPI Re: Nursing home pharmaceutical outreachprogram- final report Date: January 29, 2008 The Proper Place for Pharmacy Waste- pharmaceutical outreach project for nursing "home" facilities Projectstatus: I00% complete Activities by task Projectplanningandresearch First quarter: Project coordinatorparticipated in two Webcasts during fall 2006 in preparation for this project. Two main projectplanoing meetings were held in January. The Jan. II, 2007, meeting was held in Topekawith Steve Caspers ofBOW, Joe Cronin and Maria Morey ofBWM, and LesaRoberts ofKDHE. During this meeting, we reviewed the project and methodology. Discussion related to appropriateness ofthe target audience was also reviewed, as well as the possibility ofdoing water quality testing onthe Wichitabasinusing KDHE labs in an effortto achieve baseline water quality data. A secondplanoing meeting heldJan. 24, 2007, included Sedgwick County watershed partoers Becky Gagnon, SusanErlenwein, and CarolynHosford; as well as KDHE staff members Joe Cronin, Cathy Colglazier, and LesaRoberts. Questions related to water quality testing feasibility were discussed but found notpractical by KDHE andthe city of Wichita. Discussion related to target audience showed support for moving forward with LTC facilities unless further assessment dictated a change. SBEAP staffhas metwith nursing home long-term care pharmacists, Mike White of Omnicare and Debra Billingsley ofthe Kansas Board ofPharmacy, in an effort to better understand issues related to legal options for return and disposal ofexpired pharmaceuticals. Secondquarter: Research continues as staffdiscuss and promote program elements with Kansas regulators, HHWs, and healthcare facilities, including pharmacists and nursing staff. Staffmonitor the national pharmacy waste and Hospitals for a Healthy Environment (H2E) listserves. On May 2, 2007, staffmet with KDHE staffto review the progress ofthe project and discuss findings. Based on comments and data, it was recommended staffprovide technical assistance to healthcare pharmacists beyondjustLTC as requested. Itwas discussed that development and use ofa poster in LTC may not have the impact originally discussed. This deliverable will be reassessed as the projectprogresses.

Phannaceutical outreach to nursing homes Final reportAdvisory board First quarter: No meetings have been held, but several members have been identified. Secondquarter: 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 servedto inform stakeholders ofthe program and some ofthe barriers healthcare facilities face related to finding theproperplace forpharmacy waste. The meeting lastedjustover 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 meetingheld Nov. 15,2007. Members were provided anupdate on the project, then details related to the Dec. 13 Webcast. Members offered suggestion and assistance with Webcast promotion. Membersprovided comments related to the poster content and art work. Meeting agendaincluded with attachments. Research take-back options Firstquarter: This research has begun with long-term care (LTC) pharmacists, the Kansas Board ofPharmacy, calls to local pharmacies, and discussions with one LTC facility. Kansas law allows thatunusedblister-pack medications can be returned to the original pharmacy for credit in LTC facilities. Return ofthese blister-pack medications is oftenleft up to the nursing staff. Retail pharmacies called inWichita included Wal-Mart, Dillon's, and Walgreens, all ofwhom stated they wouldNOT accept medication returns, not even in blisterpacks. BothMs. Billingsley and Mr. White explained that due to U.S. Drug Enforcement Agency (DEA) regulations, controlled substances (scheduled medications) carmot be returned and mustbe destroyed on site at long-term care facilities. Mr. White explained thatmost 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 muchliability for purposeful misuse oraccidental ingestion. Full survey results are enclosed, butbased ondatataken from a survey ofLTC pharmacists, pharmaceuticals at LTC facilities are more often drain disposed than returned. What method ofdisposal or return is utilized? drain disposal- 27 trash- 12 return processors- 14 other- 6

Pharmaceutical outreach to nursing homes 2 Final reportMethod of disposal

c Drain disposal • Trash o Returnprocessors 0 other

Secondquarter: Optimizing use oftake-backprograms was discussed in depth with our advisory board and is a primary topic when staffprovides technical assistance to healthcare pharmacists. The Kansas Board ofPharmacy is aware ofsome ofthe barriers and is working to optimize take-back options for healthcare. Third quarter: Have requested the Kansas Board ofPharmacytalk with DEA representative and provide further guidance about the legalities ofdestroying controlled substances using non-drain disposal options. Fourth quarter: PPI worked directly with Kansas DEA representative, Judy Williams, to reviewthe CFRas itrelates to return programs and disposal options for controlled substances at LTC facilities. Kansas Board ofPharmacy andU.S. DEA confirmedthat there is no legal option for return ofcontrolled substances, butthat nearly all otherexcess and expired pharmaceuticals could bereturned ifthey meet blister-pack and return criteria. DEAconfirmed that disposal options otherthan drain disposal are perfectly legal for LTC facilities as long as the drugs are rendered unrecoverable. House bill 2578, the utilization ofunused medication act, would further supporttakebackprograms, especially for LTC facilities. This HB was discussed as part ofour Webcast. Itis also included as an attachment. Site visits First quarter: One site visithas been completed andthe draft site-visit surveydocument developed for use with such is attached. This facility answered most ofthe questions via their facility administrator. This facility indicated it returned 80% ofits pharmaceuticals; the contractpharmacist destroyed controlled substances on site and otherwaste, including pharmacy waste, wastakento the local HHW facility. Secondquarter: Two otherpharmacy-waste technical assistance site visits were requested and completed athospitals. These two facilities indicated thatmore than 90% oftheirexpired or unused medications were currently being returned through a licensed processor. Pharmaceuticals still being drain disposed included partially used chemo and epinephrine IV solutions. Staffworked one on one withpharmacists andnursing staffat these locations to detail preferred and regulated waste management practices and

Pharmaceutical outreach to nursing homes 3 Final reportprovidedresources, including a copy of"The Blueprint for Pharmacy Waste Management" andthe HERC guide for pharmacy waste management. Staffworked with two otherfacilities reviewing and providing comments to their written pharmacy waste and chemo waste management plans. Third quarter: Completed another sevenpharmacy-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 invarious Kansas locations. This included nine larger long-term care facilities, three ofthe largest hospice**organi:~;ations,** three hospitals, and one medical clinic. Staffalso 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 ofsite-visit survey results for the most pertinent questions follows. )> Using a scale from 1to 10 (10 beinghighest), clients ranked theirfamiliarity with environmental impacts related to pharmacy waste disposal practices as a 6. )> 100% ofclients indicated licensed nursing staffand pharmacists were the responsible for disposal ofpharmaceuticals. )> 100% ofclients indicated that eitherthe director ofnursing and/orthe contract pharmacistwould be the responsible party for setting disposal policies. )> 100% clients indicated they drain-disposedpartially used liquidpharmaceuticals and controlled substances. )> 33% indicated they drain-disposed ofotherpharmaceutical, evenblisterpacks, that may otherwise meetthe criteria for returning. Lack ofunderstanding and communication with contractpharmacist was noted as the main reason for this additional drain disposal ofexpired or excess pharmaceuticals. )> 67% indicatedthey fully utilized the return program, except when it came to bulk liquids and controlled substances. None realized they coulduse a solidification approach and landfill the pharmaceuticals that could not be returned. )> 100% ofthe LTC and hospice facilities visited on site were categorized as small quantity generators (SQG). These facilities generate very few, ifany, RCRA hazardous pharmaceuticals. OtherRCRA hazardous waste related to maintenance was identified, but only atthe SQG level. )> A total of501 grams ofpatient care-related mercury was identified at three

Pharmaceutical outreach to nursing homes 4 Final reportfacilities. Informationrelated to elimination and recycling was provided.

Research disposal options through localHHWs orSQGprograms Firstquarter: Nationally, PPI has researched HHW and SQG pharmaceutical collection programs, including those in Wisconsin, Florida, and Washington state. Information related to the programs inWisconsin was shared with BWM stafflast winter. Locally, PPIhas metwith Sedgwick County staffwho indicate they will continue to take pharmaceuticals from bothresidents and SQGs. PPI has spoken with four otherHHW programs. Two small programs indicate they will take the waste, andtwo otherlarger programs, Wyandotte and Johnson counties, indicated they do not wantto knowingly accept the waste or advertise its acceptance. BWMhas indicated they will provide PPI with a list ofthe HHWs that will accept the waste. PPI provided comments to the new technical waste management guidance document. Secondquarter: PPI has providedthe new BWM guidance documentto several entities and encouraged use ofHHWs for pharmacy waste disposal in Sedgwick County. Atthis time, BWMhas not established a list ofHHWthat will collect pharmacy waste, but staff will continue to work withBWMon expanding and promoting disposal options through HHWs and SQGprograms. A call to the state poison control hotline revealed that hotline staffstill used to recommend drain disposal, butnowhave the BWM guidance and will provide the informationto clients. Administrative pharmacy staffatpoison 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. Thirdquarter: Met on site with Sedgwick County's newHHW director to confirm and coordinate efforts related to collecting pharmacy wastes from qualifying long-term care facilities. Fourth quarter: Continued to promote use ofSedgwick County SQG program to LTC facilities. Provided program brochures during on-site visits and includedprogram contact information and location in all reports. Provided HHW program information within articles and as part ofradio and television interviews. Develop targetededucation material First quarter: PPI provided comments to the new technical waste management guidance document. Secondquarter: Usingthe newBWMtechnical guidance document, staffhas encouraged non-regulated entities to follow the waste managementhierarchy and discouraged use of the drain-disposal option. BOW and PPI management discussed that development and use ofa poster inLTC may not have the impact originally discussed. This deliverable will be reassessed as the projectprogresses. During site visits and atpresentations, staff are utilizing previously developed national pharmacy waste managementresources, "The Blueprint for Pharmacy Waste Management," and the HERC seven-page guidance on pharmacy waste, in addition to BWM technical guidance.

Pharmaceutical outreachto nursing homes 5 Final repmtThird quarter: Continue to assess poster deliverable need and subsequent development as technical disposal issues are reviewed. Will discuss deliverable with BOW in October during projectupdate meeting. Fourth quarter: Determinedneed for poster at meeting with BOW. Poster was drafted andreviewed by BOW, BWM, and other advisory board members. Final product published in early December when DEA confirmed legal disposal ofcontrolled substances at LTC facilities could include solidification and land-filling. Five hundred four-color posters were published, 300 ofwhich were also laminated. To date, nearly 400 posters have been distributed, with requests for theposters coming in viahotline and our Web page several times a week. Conference presentations andarticles First quarter: First-quarterpresentations related to this topic were made to a group of about 50 LTC pharmacists attheir annual state workshop, Feb. 18,2007. Aspartofthe presentation, bothpre andposttests were given. A swnmary ofthese survey results and a copy ofthe presentation are enclosed. Highlights from the survey indicated the following: • About 80% or more ofthe pharmacists are responsible for disposal ofmedications. • Pharmacists are responsible for determining how expired or excess pharmaceuticals are handled 95% ofthe time. • Some ofthe pharmaceuticals managed are RCRAhazardous- some P-listed or acutely hazardous. • About 55 %ofthe pharmacists indicatedthat nursing staffare responsible for disposal orreturn ofnon-controlled substances. • On a scale from 1to 10, with 10 as the highest, pharmacists ranked the importance of this topic to their profession as a 9. When asked what type ofchanges they might make 

### as a result ofwhat they learned duringthe presentation, the following answers were provided: o Changes related to waste managementregulatory compliance?- 16 o Changes to evaluate disposal practices?

- 25 o Review ofwaste handling practices with nursing staff?

- 28 o Ensure return opportunities are fully utilized?- 18 o Implement waste minimizationpractices?

- 23

Pharmaceutical outreach to nursing homes 6 Final reportEnsure 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 ofabout 15 was completed at the KDHE WORKS! Conference, March 28, 2007. This audience was mainly HHW staffand otherinterested parties. An overview ofthe project was described, and the new BWM pharmaceutical waste management technical guidance document was featured. Secondquarter: The ProperPlace 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 ofHomes 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. Anews release was published and the topic was featured on at least two radio stations and onthree television stations. Two different articles for KDHE were submitted, as well as articles to Kansas Board ofPharmacy, Kansas Pharmacists Association, Kansas Association ofHomes and Services for the Aging, Kansas Department on Aging, and AARP. Workwith DOA to addpharmacy waste infOrmation to state survey Thirdquarter: 

### 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.ortFourth quarter: Kansas Department on Aging presented as part ofour 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 partof their site surveys. E-mail distribution listfOr LTCcontacts Third quarter: A list of37 contacts has been assembled and utilized for release of informationrelated to program activities andpromotion ofrelated pharmacy waste managementtraining 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 andpromotional items were released viathis e-mail group list. Many questions came to PPI viathese e-mails. Development of a pharmacv waste Web page atwww.sbeap.org Thirdquarter: A separate pharmacy waste management Web page has been developed at www.sbeap.org. A copy ofthe main home page is attached. Fourth quarter: Clients used the site to register for the Webcast and then viewWebcast presentations and related documents. The dedicated Web page atwww.sbeap.org has beenpromoted 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 ofthose visits were recordedjustthis month (January 2008). The Web castpage was visited or used 141 times, 44 ofwhich were recorded this month. This data supports requests for funding to continue this project. Hosta pharmacv waste teleconference Thirdquarter: This eventhas been scheduled as a Webcast to be held on Dec. 13, 2007, at 9 a.m. Central. The event is being promotedthrough several SBEAP and pharmacy waste program avenues. Attendees canregister viathe Web site orthrough a toll-free number at 800-578-8898. The call-in number and presentation will be providedto registrants priorto the event. No special software ortechnology will be required tojoin the Webcast. The 60-minute Webcast will provide an overview ofthe program and recommended alternative disposal practices. Featured speakers include the following: )- Caryl Gill, Kansas Department on Aging (confirmed) )- DebraBillingsley, Board ofPharmacy (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 extraphone lines. A total of55 participants preregistered for the event which featured the following three speakers: )- Becky Gagnon-Lewis, city ofWichita )- Caryl Gill, Kansas Department onAging )- Nancy Larson, K-State PPI

Pharmaceutical outreach to nursing homes 8 Final reportA copy ofthe Webc()st presentation is included in the attachments. The event drew lots ofinterestfrom LTC nursing staff, LTC contract pharmacists, and some hospital pharmacists. A few technical assistanceproviders from other states also participated. 

### Develop Phase IIprojectproposal Fourth quarter: Discussed Phase II possibilities with BOW at an October meeting. PPI will be happy to provide a formal proposal ifrequested. Elements ofthe proposal would include- )> Continuetechnical assistance )> Publish more posters )> Host additional Webcasts )> Utilize a P2 intern 

### Measures: • An attempt to gather andreview nationalandKansas baseline data- Determined not feasible during May 3, 2007, call with BOW. 

### • Advisory boardparticipants andcalls 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 ofeducational material have been distributed as partofthe 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 orvisited 849 times since being posted in September. 161 ofthose visits were recordedjustthis month. The Web castpage was visited or used 141 times, 44 ofwhich 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 publishedthe articles in newsletters reaching several hundred recipients. 

### • Media features News releasepublished from K-State mediarelations ledto two radio interviews and three television interviews. 

### • Presentations to relatedassociationspromoting theprogram - Presentations made to six related associations orgroups, for a total attendance ofmore than 150 participants. 

### • E-mail distribution listparticipants- Distribution list to 38 participants developed and utilized several times to promote pharmacy waste managementtrainings and related events. 

### • Webcast/teleconferenceparticipants- Fifty-five participants pre-registered for the Webcast. 

### • Survey datafrom Kansas Department of Aging

## if able to addthis item to their survey procedure- No data collected by DOA.

Pharmaceutical outreach to nursing homes 9 Final report• Pounds/doses ofpharmaceuticals diverted from POTWthrough otherwaste managementoptions

- At least one clientreports eliminating 1500 doses of pharmaceuticals from drain disposal each month as a result ofour on-site assistance. • Grams/pounds of mercury eliminated- 50I grams ofmercury identified for elimination. Problems anticipatedor changes needed First quarter: • Contract was delayed and initiated in late March instead ofJanuary 2007. This did not delay work start,justcharges to the account. • Proposed poster for LTC facilities may need to be adjusted due to information discovered related to the flushing ofcontrolled substances and dermal patches, which instructpharmacists to "fold and flush." · • Shouldproject staffprovide compliance assistance related to RCRA hazardous waste as a part ofthis outreach? Many facilities need to dispose ofP- and Ulisted RCRA wastes. • Despite regulatory requirements, many hospital pharmacists still flush expired medications. Thirdquarter: Delays in promoting some alternative disposal options due to waiting on Kansas Board ofPharmacy and U.S. DEA recommendations or approval. Attachments Firstquarter: • Presentation to long-term care pharmacists • Summary of pre- andpost-test surveys ofLTC pharmacists • WORKS! Conference presentation • DraftLTC site-visit survey form Secondquarter • Advisory board: members roster, meeting agenda, and minutes • Summary ofevaluations from Kansas Healthcare Engineers Association State Conference • Summary ofevaluations from Kansas PharmacistAssociation State Conference Third quarter: • Newsletter articles Fourth quarter: • Advisoryboard agenda • Summary ofevaluations 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