Making Medicine Mercury Free Implementing a MercuryElimination Plan MMMF Award Process

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Making Medicine Mercury FreeImplementing a
Mercury-Elimination Plan MMMF Award Process
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Why Bother?

• AHA/EPA Goal to Eliminate Mercury in health care.
  Goal of 50 MMMF awards in next round!
• Ethical responsibility/Mission Statement
• Environmental/Public Health
• Regulatory Compliance/Liability
• Safety
• Press coverage and awards
• Community Relations
• Patient/Employee satisfaction
• Potential Cost Savings

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Environmental/Health Impact

• Medical waste incinerators are major source of
  mercury
• AHA-EPA Memorandum of Understanding - 1998
• FDA and state fish consumption advisories
• New York Academy of Sciences Report
• National Resource Council (NRC) Report
• AMA, ANA, APHA resolutions

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The Fish Connection
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www.h2e-online.org
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Obstacles to Mercury Elimination

• Mercury is considered the Gold Standard
• Clinicians are trained on mercury devices
• Cost of replacements
• Old habits

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Be like Mercury Persistent!

• Designate team leader
• Pilot Start Small if you need to
• Take a team approach include multiple
  departments
• Check with your GPO Were driving markets!
• Educate

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Clinical Sources

• Sphygmomanometers
• Thermometers
• Barometers
• Bougies, cantor tubes
• Pharmaceutical Preservatives

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Facilities Management

• Light Bulbs
• Switches
• Thermostats
• Batteries, electronics

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Laboratories Sources

• Laboratory chemicals
• Thermometers
• Cleaning chemicals

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But FirstManage what you have!

• Education
• Segregation
• Labeling
• Spill Response
• Monitoring
• Removal
• Record keeping

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Shut the Door to Mercury

• Identify mercury-containing products purchased
  for your facility
• Prioritize items Major source is
  sphygmomanometers and cantor tubes.
• Identify/pilot alternatives to mercury-containing
  products
• Develop a policy for mercury elimination plan
• Educate department heads and purchasing agents
• Monitor and track. Newsletters, education

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H2E National Awards

• Making Medicine Mercury Free
• Partners for Change
• Partner Recognition
• Environmental Leadership Award
• Champion for Change
• Internal Awards Process

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MMMF Award Facts

• You have to be an H2E partner.
• You can apply any time during the year.
• This is a one-time award.
• You dont have to be 100 mercury free to be
  eligible.
• H2E can walk you through the process.
• H2E will inform you in 30-60 days.

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MMMF Award Application

• Click on MMMF form and save as a file.
• http//www.h2e-online.org/pubs/awards/MmmfForm60.
  doc.
• Provide back-up documentation
• Send in via email wherever possible and send in
  mail back-up information.
• Contact H2E for more information.
• 1/800-727-4179 or h2e_at_h2e-online.org

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1. Facility Information

• Adjusted Patient Days
• Adjusted patient days TTL patient days X (TTL
  Patient Revenue (Inpatient outpatient)/Inpatient
  Revenue
• Admitting or finance will have this data
• of licensed beds
• For long term care - of beds and of FTEs

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2. MMMF Award Check List

• Established Mercury Facility Policy Statement
• Established a Mercury Management Policy that
  includes
• Protocols for safe handling
• Mercury Spill Cleanup Procedures
• Disposal Procedures (recycling or regulated safe
  disposal to avoid disposal in the waste stream.)
• Education and Training of facility protocols
  including information about mercury and its
  effect on human health and the environment
• Process to regularly review mercury use reduction
  and elimination progress for continuous quality
  improvement.

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3. EPP Policy

• Implemented Environmentally Preferable Purchasing
  Policy that bans the purchase of
  mercury-containing products without prior
  approval.
• (Attach Policy)

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4. Thermometers

• Replaced all mercury-containing thermometers
  including those sold in pharmacy and sent home
  with patients.
• Manufacturer of nonmercury thermometer now in use.

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5. Sphygmomanometers

• Replaced all or majority (75) of
  sphygmomanometers and have a replacement plan and
  phase out timeline in place for total
  elimination. What has been replaced? If not
  100, what is the timeline?
• Attach supplemental information.

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6. Other clinical devices

• Replaced all or majority (75) of clinical
  devices including bougies, miller abbot tubes,
  dilators etc Description of which have been
  replaced and name of alternative. If not 100
  eliminated, timeline of complete elimination.
• Attach supplemental information.

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7. Other clinical devices

• Implemented program to recycle fluorescent light
  bulbs.
• Name of vendor.
• Attach supplemental information.

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8. Battery Collection

• Implemented program to recycle batteries.
• Name of vendor.
• Attach supplemental information.

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9. Inventoried Facilities

• Inventoried and labeled all mercury-containing
  facility devices (switches, thermostats etc..)
• Plan in place to substitute nonmercury devices.
  Attach description of which items have been
  replaced and describe the plan and timeline to
  totally eliminate remaining devices.

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10. Labs

• Replaced B5/Zenkers Stains with nonmercury
  substitute. What replacement are you using?

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11. Lab Inventory

• Inventoried mercury-containing lab chemicals with
  a plan for substitution.
• Describe process and plan for substitution.

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12. Inventoried Lab Thermometers

• Replaced at least 75 with a total phase out plan
  in place. Provide timeline for 100 replacement.

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13. Other chemicals

• Other mercury containing products. What are
  other challenges? (Pharmacy, Cleaning chemicals,
  dental amalgam and other and which products.)
• Other innovative programs? Outreach? Community
  initiatives?

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III. H2E Goals

• Facility goals and describe any activities
  including source reduction.

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MMMF Award Application

• Award Application Check List
• Mercury Elimination Policies
• Mercury Management Policy
• Environmentally Preferable Purchasing

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MMMF Award Check-List

• Partner of H2E
• MMMF Award Application
• No outstanding OSHA violations
• 3 copies of everything
• Back up/Supporting information
• Email and send in regular mail

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Tools

• H2Es 10 Step Guide to Recycling Fluorescent
  Lamps
• http//www.h2e-online.org/pubs/tensteps/fluor10st
  eps.pdf
• HCWHs Guide to Battery Collection
  http//www.noharm.org/library/docs/Going_Green_Bat
  ter_Roundups_-_Get_Charged.pdf
• NIH List of Mercury-Containing Lab Chemicals and
  Equipment and Alternatives http//www.nih.gov/od/
  ors/ds/nomercury/alternatives.htm
• Cal DHSs Mercury Manager tool
  http//www.h2e-online.org/tools/merc-man.htm
• (click on Mercury Assessment Worksheet)
• HCWHs List of Mercury-Containing Items in a
  Healthcare Setting http//www.noharm.org/library/
  docs/Going_Green_List_of_Mercury-Containing_Items_
  i.pdf

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H2E Resources/Guidance

• Awards Process
• www.h2e-online.org/programs/award/index2004.htm
• Mercury Backgrounder
• www.h2e-online.org/tools/mercury.htm
• Measuring Blood Pressure Accurately
• http//www.noharm.org/mercury/sphygmo
• List serve www.h2e-online.org/programs/list.htm
• Universal Waste Guidelines
• www.h2e-online.org/tools/univwaste.htm
• 10 steps to bulb recycling
• www.h2e-online.org/tools/univwaste.htmflu
• Mercury Elimination Plan
• www.h2e-online.org/pubs/mercurywaste.pdf
• Fish Advisories
• www.h2e-online.org/tools/merc-oth.htmfish
• H2Es Healthier Choices for Electronic Equipment
  
• From Procurement to the End-of-Life
• http//www.h2e-online.org/pubs/Pub7-01-HealthierCh
  oices.pdf

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Other Mercury Resources

• Massachusetts Academic Scientific Community
  Organization www.masco.org
• U.S. Food Drug Administration -
• www.cfsan.fda.gov
• Health Care Without Harms Fast Facts -
• http//www.noharm.org/library/docs/Going_
• Green_The_Mercury_Problem_-_Fast_Facts.pdf
• HCWH Making Medicine Mercury Free Resource Guide
  -
• http//www.noharm.org/library/docs/Going_
• Green_Making_Medicine_Mercury_Free.pdf
• American Medical Association www.ama-assn.org

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Sustainable Hospitals Project
www.sustainablehospitals.org
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Premier Inc.s Free List of Mercury Containing
Pharmaceuticals
http//www.premierinc.com/all/safety/resources/mer
cury/premier_products.jsp
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Dental Mercury

• Dental Mercury Removal Systems

http//www.sustainablehospitals.org/cgi-bin/DB_Rep
ort.cgi?pxWrptCatid25
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Dental Mercury

• Dentist the Menace

http//www.noharm.org/library/docs/Dentist_the_Men
ace.pdf
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Compliance Assistance for all Regulatory
Oversight of Healthcare
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Need Help?

• Hospitals for a Healthy Environment
• www.h2e-online.org
• 703-243-0056
• Partner Coordinator -Janet.brown_at_h2e-online.org
• 413/259-1890
• Champion Coordinator
• Sarah.obrien_at_h2e-online.org
• 802/479-0317
• State Program Coordinator
• Cecilia.deloach_at_h2e-online.org
• 1/800-727-4179
• Director
• Laura.brannen_at_h2e-online.org
• 603/795-9966