“Sharps Disposal Service” Faxback Form

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MetoJect® Disposal Programme
Patient Instructions
Procedure for MetoJect® Sharps Disposal
Please read these instructions carefully
You have been prescribed with Metoject® as part of your homecare regime. As this
prescription requires administration of the drug at home it is important that the disposal of
used needles and syringes is carried out in a responsible manner. To that end, a service is
offered by Fannin to supply you with a suitable container to store used needles and syringes,
which will periodically be disposed of by a licensed contractor, SRCL.
The following instructions should be followed.
 The container supplied to you should be kept in a safe place in the home. Please keep the
container out of the reach of children, if possible in a press that can be locked.
 Only Metoject® needles and used syringes should be placed in the container,
through the small opening in the lid of the container. Remove the blue shoulder on the
syringe prior to placing the needle/syringe in the sharps container.
 The container has a lockable twist lid. Please note that whilst in use the lid should only be
twisted once to cover the opening. If the lid is fully twisted until it clicks the container will
lock and you will be unable to open the container. This ‘full twist and click’ procedure
should only be carried out when the container is full and requires disposal.
 Disposal of the full container will be carried out either by collection directly from your home
or by an arrangement with the pharmacy that supplies your prescription – Note: Prior
agreement with your pharmacist is required if this option is chosen.
 If you have such an arrangement with your pharmacist, you should return the full container
to the pharmacy who will notify the licensed disposal contractor and arrange for collection.
To arrange delivery of a replacement container, you should contact your pharmacist in
advance.
 If collection is made from your home contact SRCL on 01 4659136 to arrange. A
replacement container will be supplied to you at the time of collection
Should you have any queries or require any further information please contact Customer
Services at Fannin at 01 2907000.
CSDF20 – MetoJect Sharp Bin Collection Form Rev2
MetoJect® Disposal Programme
Pharmacist Information
Procedure for Registration and Waste Collection
Metoject® may be prescribed as part of homecare treatment for administration at home. It is
therefore important that the disposal of used needles and syringes is carried out in a
responsible manner. To that end, a service is offered by Fannin to supply a suitable container
to store used needles and syringes which will periodically be disposed of by a licensed
contractor, SRCL.
The following instructions should be followed to register for this service:
 In consultation with your patient, complete the attached MetoJect Disposal form and
return to Fannin Customer Service Department either by post or by fax.
 Fannin will then assign a MetoJect Reference Number and register the details for waste
disposal collection with SRCL.
 Following registration, a cytotoxic sharps bin, labelled with the MetoJect Reference
Number, will be delivered to the waste disposal point chosen.
 Disposal of the full container will be carried out by collection direct from the nominated
pharmacy or home when requested. Replacement bins will be provided on day of
collection or in advance on request.
 Note: Pharmacy collection only following prior agreement of the pharmacist.
 In the case of pharmacy collection, the patient should return the full container to the
pharmacy. To arrange collection and advance delivery of a replacement container,
telephone SRCL on 01 4659136, quoting the MetoJect reference number located on the
side of the MetoJect sharps bin. A replacement container will be sent immediately by post.
 If the patient selects home collection, this will be carried out on request. A replacement
container will be supplied at the time of collection
Should you have any queries or require any further information please contact Customer
Services at Fannin at 01 2907000.
Fannin
MetoJect® Disposal Programme
Please return this form to
Fannin House
Customer Service Department
South County Business Park
Leopardstown
Dublin 18
Tel
Fax
01 2907000
01 2907111
This service is provided for
Metoject® waste disposal only
Please complete all compulsory
sections of this form in full
MetoJect® Waste Disposal Programme
PLEASE COMPLETE THIS SECTION IN FULL
PATIENT DETAILS
ADDRESS 1
ADDRESS 2
TEL
MOBILE
PLEASE COMPLETE THIS SECTION IN FULL
PRESCRIBING CONSULTANT NAME
HOSPITAL NAME
TEL
FAX
THIS SECTION IS ONLY TO BE COMPLETED IF OPTING FOR PHARMACY COLLECTION / DELIVERY
PHARMACIST NAME
PHARMACIST SIGNATURE
DATE
PHARMACY DETAILS
ADDRESS 1
ADDRESS 2
TEL
FAX
PLEASE COMPLETE THIS SECTION AS DIRECTED
Please tickthe relevant option/s below - If neither is required – please leave blank
Please deliver MetoJect® sharps bin
Please collect MetoJect® sharps bin
NOTE
If you have already received a MetoJect® sharps bin from your hospital or Point of Care
Nurse - please note the MetoJect ID number here:
MJ/______/_______
Fannin
MetoJect® Disposal Programme
Who provides and pays for the service
The service is provided free of charge to you by SRCL, on behalf of Fannin the licensed
distributor of MetoJect®.
Responsibility for Storage
Whilst the Sharps container is in my possesion I agree to store it responsibily and out of
reach of children.
Request for MetoJect® sharp bin container service
I have read and understand the Metoject® Sharps container service leaflet. I am happy for a
SRCL representative to contact me and call to my home for the purposes of the service.
I hereby authorise Fannin / SRCL to hold and use my personal details for the purposes of
providing me with the Metoject® Sharps container service both during and for a reasoanble
time following my participation in the service, in accordance with its obligations under the data
protection act 1998 and 2003.
Signature
Print Name
Date
Fannin
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