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Phatmaceutical waste and nursing practice nurcing practiceAfter years of working to protect British Columbia's parklands, Bill Pritchard decided to become a registered nurse. Today he combines his passion for nature with his responsibilities as a registered nurse while meeting RNABC's Standards for Registered Nursing Practice in British Columbia.

After a 20-year career with BC Parks as a back country ranger in the West Kootenays (mixed with ski patrolling, maintaining remote access ski huts, and working in various other forestry and wildlife capacities in the off-season), some friends were surprised to learn that Bill Pritchard was entering nursing school. But Pritchard needed a change. Despite his love of the outdoors, he had grown tired of being on the road, and wanted more time at home with his family.

To Pritchard, the career move was a fairly natural progression. He had always enjoyed the challenge of learning new things, and in some ways nursing would build on his background. "It didn't seem that far (a stretch) to me," he says. "I had many years of experience in first aid, was a volunteer in search and rescue, and enjoy working with people." Nursing was service to the public in a new, but related area.

Pritchard graduated in spring 2003 from the Collaborative Curriculum Program at Selkirk Community College in Castlegar. Since then he has worked more than full-time casual hours on a medical floor at Kootenay Lake Hospital. "Nursing has offered me a profession in which continual learning is a must," he says. "I have found it mentally challenging and exciting. Not one day goes by that I don't learn something from working with a patient or my colleagues - RNs and LPNs who have amassed an amazing amount of knowledge."

But the learning has become a two-way street. Pritchard's colleagues are learning from him as well. He has become a knowledgeable resource on a topic that combines his passion for nature with his professional nursing responsibilities. As a source of current information and thought-provoking questions for his peers, and as an advocate for change in nursing practice, he is also meeting the Standards for Registered Nursing Practice in British Columbia. In particular he demonstrates clinical practice indicators for Standard 2: Specialized Body of Knowledge - Bases practice on the best evidence from nursing science and other humanities, and Standard 5: Provision of Service in the Public Interest - Provides nursing services and collaborates with other members of the health care team in providing health care services.

The story begins in a hospital medication room while Pritchard was in nursing school. It was the first time he saw wasted medication discarded into the sink or garbage. For Pritchard, whose father was a scoutmaster and whose mother had insisted on environmentally-friendly household products long before the term was popular, it was all wrong.

"I had a gut reaction," he says. "I thought, 'That's not good. I don't litter on the street, why would I do it here?'"

Years of work protecting and enjoying B.C.'s parklands told him that the practice of casually dispensing pharmaceutical waste was bad for the environment, and not in the best interests of the public.

Pritchard's response was intuitive rather than grounded in fact. His body of specialized knowledge related to pharmaceutical waste management and nursing practice developed later during a teaching/learning course. The assignment was to develop and implement an educational program that demonstrated the application of learning concepts. One student, for example, taught other students how to find and use the ventro-gluteal site for IM injections. Pritchard chose to use this project as an opportunity to further his knowledge on the subject of best practice for pharmaceutical waste disposal in hospitals. The topic idea was supported by his instructors as a challenging, but worthwhile project.

Challenging indeed. He found nothing on his subject in the nursing literature. A broader online search yielded a wealth of information on topics such as cost reduction through hospital waste management, the effects of antibiotic waste on agriculture and the safe disposal of needles. It was a start.

Next, Pritchard targeted the Web sites of international organizations, such as the United Nations, the World Health Organization and Health Care Without Harm (an international coalition of 427 organizations in 52 countries working to transform the health care industry so it is no longer a source of harm to people and the environment). He e-mailed health and environmental interest groups. He contacted hospital managers, government bureaucrats and the B.C. College of Pharmacists. He also contacted the B.C. Ministry of Water, Land and Air Protection. Information he received provided clues to more sources of information. His search grew as he became familiar with such terms as "pharmaceutical and personal care products" (PPCPs). He found studies, policy guidelines, and discussions all related in varying degrees to his topic of pharmaceutical waste disposal and nursing practice.

Through his research, Pritchard was demonstrating Standard 2 - Specialized Body of Knowledge, Indicator 1: Knows how and where to find needed information to support the provision of safe, appropriate and ethical client care. Unable to find specific information in nursing literature, he went further afield in keeping with Standard 2.

Pritchard's extensive research process paid off in surprising ways. The mother of a classmate sent one article to him from Montreal. Somehow the mother had learned of Pritchard's interest and e-mailed him a story from The Globe and Mail newspaper via her daughter. The article referred to the results of a Canadian study that found low concentrations of pharmaceuticals in water samples taken near sewage treatment plants in 14 cities. The drugs found included analgesics, anti-inflammatories, anticonvulsants and lipid regulators. A conclusion in the article was that current sewage treatment facilities are not adequately equipped to handle pharmaceuticals (Stevenson, 2002).

Pritchard was unable to get a copy of the actual study as it was still going through a peer review process. However, the article in The Globe and Mail quoted Mark Servos, a scientist at Environment Canada's National Water Research Institute with whom he was able to correspond through e-mail on the subject of PPCPs in the environment. Servos sent him proceedings from a workshop sponsored by Health Canada and Environment Canada in which participants representing government, academia and industry addressed the potential impact of PPCPs in the environment relevant to human and ecosystem health. Hospital wastewater effluents and disposal practices for unused drugs were identified as major sources of concern (Servos et al., 2002).

This theme of general concern was echoed in all Pritchard's research. He admits that while there is ample speculation, the impact of low concentrations of pharmaceutical waste from hospitals on human health is unknown. Still, he believes there is more than enough indication in the literature to warrant the attention of registered nurses.

Pritchard's teaching project took shape as a Power Point presentation entitled Pharmaceutical Waste Management: The Environmental Impact of Nursing Practice. His goal was to raise awareness of the relationship between nursing actions and the environment. It provided facts gathered from his research and posed questions to facilitate discussion on current nursing practices: "Where do you discard used IV bags?" "What about used vials and ampoules?" "Where does the garbage end up?"

He also included the few specific guidelines he found on the safe disposal of pharmaceutical waste and residues in hospital medication rooms. The guidelines are included in a handbook entitled Safe Management of Wastes from Health Care Activities (available in PDF format at medicalwaste/wastemanag/en/), published by the World Health Organization. According to these guidelines, small quantities of pharmaceutical waste should be treated as hazardous and, as such, disposed of in yellow leak-proof containers, the contents of which should be incinerated or safely buried. It should be noted that there is separate discussion in the handbook of the handling of cytotoxic drug waste, which should never enter the sewer system or the landfill (Pruss, Giroult, & Rushbrook, 1999).

For his course, Pritchard presented at his local RNABC chapter meeting. The response from peers was positive and the chapter president encouraged him to present to the Issues Forum at the 2003 RNABC Annual Meeting.

It wasn't an easy thing to take on, but Pritchard followed up with great success at the Annual Meeting. "I had been pretty nervous about presenting to 400 nurses on a topic that is important to me and was worried about coming across poorly," he says. "The support was phenomenal. The response . . . floored me.