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© Product Stewardship Institute, Inc.May 2008
PSI National Dialogue on Medical Sharps
Boston, MAMay 21-22, 2008
© Product Stewardship Institute, Inc.May 2008
What is the Product Stewardship Institute?
Non-profit, based in Boston, founded in 2000 Membership
44 State members 51 Local agency members 20 Adjunct Council members
Board of Directors: 7 states, 4 local agencies Multi-stakeholder product stewardship network Adjunct Council: business, environmental/organizational
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© Product Stewardship Institute, Inc.May 2008
PSI Full and Affiliate State Members
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© Product Stewardship Institute, Inc.May 2008
Why was the Product Stewardship Institute Created?
Unified voice: State and Local Governments Fiscal relief for government on waste issues Objective data for decision-making Forum for collaboration with industry Nationally coordinated systems/harmonized
regulations
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© Product Stewardship Institute, Inc.May 2008
PSI Projects
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Medical Sharps
Pharmaceuticals
Fluorescent lamps
Mercury Thermostats
Paint
Electronics
Radioactive Devices
Telephone books
Gas Cylinders
Tires
Beverage containers
Packaging
Batteries
Motor oil
© Product Stewardship Institute, Inc.May 2008
What is Product Stewardship?
“Product Stewardship" is a principle that directs all those involved in the life cycle of a product to take shared responsibility for reducing the health and environmental impacts that result from the production, use, and end-of-life management of the product.
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© Product Stewardship Institute, Inc.May 2008
PSI Role in Dialogue
Research
Facilitate/mediate dialogue meetings
Implement projects & initiatives
Evaluate projects
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© Product Stewardship Institute, Inc.May 2008
PSI’s “Agenda”
• Promote product stewardship solutions• Reduce product impacts• Forge partnerships that share responsibility
– Product management– Sustainable financing
• Get results – not just discussion
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© Product Stewardship Institute, Inc.May 2008
Meeting Objectives
• General agreement on:– Stakeholder roles/process– Issue statement– Dialogue goals
• Confirm road map
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© Product Stewardship Institute, Inc.May 2008
Meeting Objectives
• Learn from presentations and research• Explore priority issues and strategies• Establish work groups on 2 priority strategies• Determine next steps
– Meeting date/location– Stakeholder assessment
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© Product Stewardship Institute, Inc.May 2008
Priority Issues and Strategies#1 – Source reduction#2 – Collection, transportation, and disposal
infrastructure#3 – Regulation and enforcement#4 – Sustainable financing#5 – Education, outreach, and risk
communication
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© Product Stewardship Institute, Inc.May 2008
Stakeholder Roles• Authorized to represent company, agency, or organization.• Attend 4 meetings (or via phone).• Active participation between meetings.• Jointly develop agreement.• Ensure your interests/others’ interests are met.• Participation in dialogue does not preclude legislative
activity.• Negotiate in good faith.
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© Product Stewardship Institute, Inc.May 2008
Consensus
• All participants can live with decision and no one will actively block or undermine decision.
• The greater the stakeholder agreement, the greater the likelihood that the agreement will be sustainable.
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© Product Stewardship Institute, Inc.May 2008
Consensus
• Consensus is preferable for broad initiatives: – Technical standards– Policies– Legislation
• Consensus is NOT needed for pilot projects or individual initiatives.
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© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting 15
MEETING 2
MEETING 3
MEETING 1
AGREEMENTS
START
May 2008 August 2008 November 2008 February 2009
•2 Workgroups•Develop findings•Draft work plans
•Refine draft agreements
•Refine Workgroups •Develop Findings•Draft work plans
•Present Workgroup findings/plans
• Full financing discussion•Discuss additional strategies
• Present Workgroup findings/plans• Discuss additional strategies
• Start to develop draft agreements
MEETING 4
• Finalize agreements
• Develop Implementation Plan
Dialogue Meeting
Workgroup Activity
Road Map
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Possible Dialogue Outcomes
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• Pilot projects with measurable results• Demonstration project to test comprehensive
program• Model state policies (e.g., procurement)• National standards/requirements
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Possible Dialogue Outcomes
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• Business innovations/profitability studies (e.g., reverse logistics potential)
• Model state or federal legislation• Model state or national education campaign• National sustainable financing system for the
management of medical sharps
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Possible Mechanisms for Agreements
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• Letter of agreement between those involved in pilot project
• Memorandum of agreement between stakeholders stating intent to perform certain activities
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
What do we want to avoid?
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• Multiple state solutions
• Unilateral state or federal regulation
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Potential Stakeholder Contributions
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• Manufacturers (sharps and pharmaceuticals)• Pharmacy benefit managers/third party payers• Insurers• Retail pharmacies• Government agencies• Public health/other associations• Waste management companies
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Potential Contributions: Sharps Manufacturers
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Develop/promote sale of products with safety features Increase public awareness about importance of safe disposal and collection locations Produce/sell approved sharps disposal containers for sale with sharps products Manage and finance safe collection of medical sharps
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Potential Contributions: Pharmaceutical Manufacturers
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Develop/promote sale of products with safety features Increase public awareness about importance of safe disposal and collection locations Require self-injected products to be accompanied by approved sharps disposal container Manage and finance safe collection of medical sharps
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Potential Contributions: Pharmacy Benefits Managers/Third Party Payers
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Require self-injected products to be accompanied by approved sharps disposal container
Increase awareness of importance of safe sharps disposal and collection opportunities
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Potential Contributions: Insurers
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Reimburse costs of sharps disposal containers and collection/disposal of sharps.
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Potential Contributions: Retail/Mail Order Pharmacies
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Increase public awareness about importance of safe disposal and collection locations Collect used sharps on site or via mail-back Provide coupon as incentive to return used medical sharps for disposal Promote sale of products with safety features
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Potential Contributions: Government
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Oversee manufacturer collection programs Increase public awareness about importance of safe disposal and collection locations Regulation/enforcement to level playing field and maintain fairness
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Potential Contributions: Government, cont.
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Require that sale of self-injected products includes safe sharps disposal Provide existing facilities for safe consumer collection convenience Explore tax credits or other opportunities to encourage private sector participation in sharps disposal programs Explore public financing options
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Potential Contributions: Waste Management Companies
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Increase awareness of importance of safe sharps disposal and collection opportunities
Provide safe transport and treatment for sharps disposal
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Process for Developing Action Plan
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• Draft Problem Statement and Goals• Issues/Strategies• Interviews/input from over 35 stakeholders• Input incorporated into Action Plan • Draft Action Plan/comments• Input on 2nd Draft Action Plan – due 2 weeks• NOT PSI’s Issue Statement and Goals
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Issue Statement
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• Sharps are used for self-injection and blood glucose testing by people with diabetes, patients administering their own medications, and injection drug users.
• Sharps used in the “community” typically end up in MSW, recycling, or wastewater
• If not properly disposed of, sharps can pose a hazard to sanitation workers, others
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Issue Statement
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• Sharps may also be left in public places
• Sharps may damage or disable equipment
• Problem is expected to increase as number of people with diabetes rises and “biologic” drugs expand markets
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Dialogue Goal
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The primary goal of the project is to maximize the safe and environmentally sound collection and disposal of waste
sharps by developing a nationally coordinated system that is financially
sustainable.
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Dialogue Focus
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This project will focus on sharps generated outside the traditional health care setting,
including households, hotels, casinos, restaurants, airports, and other public
venues.
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Purpose of Presentations
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Educate attendees on basics
Outline current boundaries of knowledge
Illustrate product stewardship
Show potential for collaboration
Portray possibilities
© Product Stewardship Institute, Inc.May 2008
PSI Medical Sharps Dialogue Meeting
Issue/Strategy Discussions
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Background technical information
Clarify issues and strategies
Additional strategies
Prioritize strategies
Workgroups at end of 2nd day - top 2 strategies