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The general anesthetic propofol is one of the most commonly wasted drugs in hospitals and accounts for 41% of reported substance abuse cases among anesthesia providers. The lack of controlled disposal practices for propofol poses significant risks of diversion, economic waste, and environmental harm. At the Mayo Clinic, the common practice of storing propofol in unsecured bins put staff and patients at risk for misuse, while disposing of propofol down the sink led to clogged plumbing in the ICU and raised environmental concerns.
In 2017, the Mayo Clinic preformed an evidence-based practice (EBP) project to address propofol disposal. The project included (1) A review of peer-reviewed literature pertaining to environmental, economic, and diversion concerns surrounding unused propofol, as well as changing propofol disposal practice, (2) assessing current propofol disposal practice, (3) analyzing barriers to disposal, (4) implementing a new tailored approach to propofol disposal, and (5) reassessing propofol disposal practice after implementation.
During the EBP project, the Mayo Clinic distributed 280 electronic surveys to Certified Registered Nurse Anesthetists (CRNAs) on various methods of propofol disposal and received 214 responses. The survey showed 46% reported sink disposal as their most frequent practice for discarding propofol, 26% reported that their most frequent method of propofol disposal was leaving it in the vial and placing in unsecured bins in the operating room, and 24% reported disposing propofol in the garbage.
The researchers initiated a six-week trial intervention in which Deterra® Drug Deactivation and Disposal Pouches were introduced for propofol disposal in patient and operating rooms. The researchers chose Deterra because of the product’s scientifically proven proprietary activated carbon technology, which binds to the propofol as it is poured into the pouch and renders it inert, unavailable for misuse and safe for the environment. The Large Deterra Pouches (LP) last for 3-4 patients, and the plant-based pouch can then be sealed and disposed of in the normal trash, posing minimal harm to the environment.
The researchers also developed a bottle opener to make the propofol vials easier to open to encourage staff to dispose of the unused medication and reduce the number of unemptied bottles available for diversion or misuse.
Study results show that introducing carbon pouch disposal significantly decreased the percentage of unemptied propofol vials remaining in unsecured bins, from 26% before the intervention to 3% post-trial, an increase of 23% in the rate of proper disposal.
In addition to successfully reducing the diversion potential of propofol, the Deterra System has been a great addition for nurses, who can easily secure the pouches to bedsides or near trash bins in patient rooms so they can properly dispose of medication while staying with their patient.
The project results were published in the American Association of Nurse Anesthetists’ AANA Journal and the Mayo Clinic plans to continue purchasing and incorporating Deterra Pouches in its operating rooms for a safe, easy and permanent method to dispose of propofol.
Visit DeterraSystem.com/government to explore how other organizations are using Deterra or reach out to (612) 568-1128 or Sales@DeterraSystem.com to discuss how to implement at-home drug disposal initiatives in your community.
