R20 - Sustainable medicines optimisation

What is sustainable healthcare?

• Sustainable healthcare aims to provide effective patient care while minimising environmental impact and making efficient use of social and financial resources.

The goal is to improve patient outcomes without unnecessary waste.

What are the four principles of sustainable healthcare?

1. Prevention: Prevent illness and reduce the need for treatment.

2. Patient self-care: Empower patients to manage their own health.

3. Lean service delivery: Reduce unnecessary healthcare activities and waste.

4. Low-carbon alternatives: Choose treatments and technologies with a lower environmental impact.

What is sustainable value in healthcare?

Sustainable value means achieving the best health outcomes while minimising environmental, social and financial impacts.

It considers the triple bottom line:

• Environmental impact

• Social impact

• Financial impact

What are the four principles of medicines optimisation?

1. Understand the patient's experience.

2. Make evidence-based choices about medicines.

3. Ensure medicines are used as safely as possible.

4. Make medicines optimisation part of routine practice.

Overall aim: Improve patient outcomes through a person-centred approach

How does medicines optimisation contribute to sustainable healthcare?

Medicines optimisation ensures patients receive appropriate, safe and effective medicines.

It improves sustainability by:

• Reducing unnecessary prescribing.

• Preventing medicines waste.

• Improving adherence and treatment outcomes.

• Reducing unnecessary healthcare resource use.

What are the main carbon hotspots associated with medicines?

Inhalers and anaesthetics are important carbon hotspots because some release gases with high global warming potential (GWP).

Reducing their emissions can lower the environmental impact of healthcare.

How can the carbon footprint of inhalers be reduced?

• Optimise inhaler technique to prevent wasted doses.

• Ensure patients know when and how to use their inhalers.

• Choose lower-carbon inhalers where clinically appropriate.

• Consider patient preference and ability.

• Keep up to date with lower-GWP inhaler developments.

How can the environmental impact of anaesthetics be reduced?

• Choose anaesthetics with a lower global warming potential (GWP), such as sevoflurane where appropriate.

• Minimise leakage of nitrous oxide.

This reduces greenhouse gas emissions associated with anaesthetic use.

How does prevention contribute to sustainable medicines optimisation?

Prevention reduces or delays the need for medicines by improving health before disease develops or worsens.

Examples:

• Vaccination.

• Screening for hypertension and high cholesterol.

• Smoking cessation.

• Healthy diet and physical activity advice.

• Social prescribing.

What is patient empowerment, and how does it improve sustainability?

Patient empowerment involves helping patients take an active role in managing their health.

It includes:

• Understanding how and when to take medicines.

• Using medical devices correctly.

• Self-monitoring and management plans.

• Recognising when treatment is not working.

• Avoiding over-ordering medicines.

This improves treatment effectiveness and reduces waste.

How can pharmacists promote sustainable asthma care?

• Ensure timely diagnosis and appropriate treatment.

• Select inhalers based on patient needs and environmental impact.

• Check inhaler technique regularly.

• Provide personalised asthma management plans.

• Encourage trigger avoidance and appropriate vaccinations.

• Review symptoms and treatment regularly.

• Advise patients to return unwanted inhalers to pharmacies.

Why does medicines waste have a negative environmental impact?

Wasted medicines use resources during manufacturing, packaging, transport and disposal without providing clinical benefit.

Key point: Wasted medicines have very low sustainable value because they produce environmental, social and financial costs without improving health.

What are the main causes of medicines waste?

• Over-prescribing.

• Over-ordering by patients, carers or pharmacies.

• Inefficient repeat prescribing systems.

• Inappropriate quantities or lengths of supply.

• Dispensing processes and pack-size differences.

• Poor communication during transfers of care.

• Unnecessary supplies during hospital discharge or care home admission.

How can pharmacists reduce medicines waste through prescribing?

• Prescribe only when clinically necessary.

• Consider appropriate quantities and formulations.

• Review medicines regularly.

• Avoid unnecessary repeat prescriptions.

• Consider reusable devices where appropriate.

• Educate patients about safe disposal.

How can patients help minimise medicines waste?

• Only order medicines they need.

• Avoid stockpiling medication.

• Check prescriptions before leaving the pharmacy.

• Inform healthcare professionals about medicines they no longer take.

• Return unused medicines to a pharmacy for safe disposal.

Why is medicines reconciliation important for reducing waste?

Medicines reconciliation involves checking and confirming a patient's current medicines, particularly during transfers of care.

It reduces waste by:

• Identifying medicines patients already have.

• Preventing unnecessary duplicate supplies.

• Identifying medicines that have been stopped or changed.

• Improving communication between healthcare settings.

Why should patients check their medicines before leaving the pharmacy?

Medicines that remain within the pharmacy's control may be suitable for supply to another patient.

However, once medicines have left the pharmacy, they cannot normally be reused or supplied to another patient.

Checking prescriptions before leaving helps prevent unnecessary waste.

How should unused medicines and medicine packaging be disposed of?

• Return unused medicines to a pharmacy.

• Do not flush medicines down the toilet or put them down the sink.

• Medicines waste should be appropriately segregated and disposed of.

• Recycle suitable packaging after removing patient-identifiable information.

• Use specialist recycling schemes for inhalers, insulin pens or other devices where available.

What is appropriate prescribing, and how does it support sustainability?

Appropriate prescribing means ensuring a medicine is clinically necessary, evidence-based and suitable for the patient.

t involves:

• Considering whether prescribing is needed.

• Using the lowest effective dose for the shortest appropriate time.

• Involving patients in decisions.

• Regularly reviewing treatment.

• Managing repeat prescriptions effectively.

What is deprescribing, and why is it important for sustainable healthcare?

Deprescribing is the planned and supervised reduction or stopping of medicines that are no longer needed or where the harms outweigh the benefits.

It can:

• Reduce unnecessary polypharmacy.

• Lower the risk of adverse drug effects.

• Reduce medicines waste.

• Reduce environmental and financial costs.

Why may oral medicines be more sustainable than intravenous (IV) medicines?

Oral medicines may have a lower environmental impact because they generally require:

• Less single-use plastic equipment.

• Fewer administration materials.

• Less healthcare staff time and associated resources.

Example from the lecture: Comparing IV ciprofloxacin with oral ciprofloxacin.

Key point: Oral treatment should be considered when clinically appropriate.

Why may solid oral dosage forms be more sustainable than liquid formulations?

Tablets and capsules may:

• Require less bulky packaging.

• Reduce the use of plastic bottles and measuring devices.

• Reduce leftover medication and waste.

Example: The lecture compares amoxicillin liquid with capsules and highlights 95 mL of wasted liquid in one example.

Solid formulations should only be used when suitable for the patient.

What non-pharmaceutical interventions can improve healthcare sustainability?

• Lifestyle advice: Healthy eating, exercise and smoking cessation.

• Social prescribing: Community activities and social support.

• Green/blue prescribing: Activities involving natural environments.

• Psychological interventions: Support for mental health.

• Pulmonary rehabilitation: Improving respiratory health and physical function.

These may improve health and reduce the need for some medicines or healthcare interventions.

How can pharmacies reduce their environmental impact through sustainable resource use?

• Switch off unnecessary equipment and reduce energy consumption.

• Use renewable energy where possible.

• Reduce transport emissions through efficient delivery routes and lower-emission vehicles.

• Minimise unnecessary paper, bags and prescription printouts.

• Recycle suitable packaging, containers and devices.

How can a person-centred approach improve sustainability in patients with multiple long-term conditions?

A person-centred approach considers the patient's physical, psychological and social needs rather than focusing only on prescribing medicines.

Example: Pat from the lecture

Pat is 78 and has hypertension, type 2 diabetes, osteoarthritis and hypothyroidism. She also experiences social isolation, low physical activity and poor dietary habits.

sustainable approach

sustainable approach could involve:

• Supporting healthier food choices and appropriate physical activity.

• Providing counselling and social prescribing.

• Encouraging community engagement.

• Reviewing medicines to identify unnecessary treatment.

• Supporting self-management of her conditions.

Outcome: Better quality of life, greater independence and potentially fewer unnecessary medicines.

summary

Key term	Simple definition
Sustainable healthcare	Providing effective care while reducing environmental impact and resource waste
Medicines optimisation	Ensuring medicines are used safely and effectively to achieve the best patient outcomes
Sustainable value	Maximising health benefits relative to environmental, social and financial impacts
Global warming potential (GWP)	A measure of how strongly a gas contributes to global warming
Lean service delivery	Reducing unnecessary healthcare activities and waste
Medicines reconciliation	Checking and confirming a patient's medicines during transitions of care
Deprescribing	Supervised reduction or stopping of medicines that are no longer appropriate
Patient empowerment	Helping patients actively manage their health and medicines