Improving the quality of the nation's drinking water: Nursing interventions related to proper disposal methods for pharmaceuticals

Background and Issues: Increasing public concern about pharmaceuticals in the nation's drinking water is evident in the media. Several mechanisms contribute to this: normal excretory processes for persons taking prescribed medication; animal feed supplementation with antibiotics, with subsequent excretion; and the improper disposal of medications. This initiative addresses improper disposal of medications.

Description: In our community, at the suggestion of the School of Nursing, a collaborative City-University committee was formed to address this aspect of water quality. University representatives include the School of Nursing and College of Pharmacy. City departments include Water Utility, Watershed Protection, Solid Waste, and Health and Human Services. These subject matter experts have met to identify best practices on the disposal of medications, including how to implement successful strategies to improve water quality in an austere economic climate.

One intervention is to educate nursing students on proper disposal of pharmaceuticals, with the aim of practicing nurses educating patients about correct practices. Another intervention is to ascertain, via surveys, current practices of City residents on disposing leftover or unused medications. The survey process is underway with a report on findings due June 2010.

Lessons Learned: • The committee was reluctant to initiate a full-blown public education campaign with the current FDA recommendations for disposal. The rationale was these guidelines (mix crushed medications with kitty litter or coffee grounds and discard in a container into the trash) are an interim solution. The long-range goal is a take back program with incineration. The means to start such a program are not available at this time. • Content on proper disposal of medications is being incorporated into the nursing curriculum at our University, specifically in the first two semesters of upper division nursing courses. The FDA guidelines are being used, with reminders that such guidance evolves as best practices are determined.

Recommendations: • The nursing curriculum approach could be replicated in associate degree and BSN programs. • The survey findings will be useful to 1) design future public education campaigns and 2) as assessment data for a newly formed legislatively mandated State Commission to address this same issue.