Improving the segregation of pharmaceutical waste across Hampshire Hospitals Foundation Trust

Project completed as part of the 2024 Hampshire Hospitals NHS Foundation Trust Green Team Competition.

Team members:

• Helen Murphy – Trust Waste Facilities compliance manager
• Rachael Aitken – Lead nurse for patient support services

Setting / patent group:  

• Hampshire Hospitals NHS Foundation Trust (HHFT)– all staff and visitors

Issue:

Effective waste management and disposal is crucial to avoid contamination, protect public health, and ensure proper disposal. Healthcare waste must be segregated in accordance with HMT07-01 The Safe and Sustainable Management of Healthcare Waste. This splits waste into specific bags which are then disposed of appropriately. Where an audit of this process is failed, all bagged waste must be incinerated. 

After failing such an audit in November 2022, Royal Hampshire County Hospital (RHCH) and Andover War Memorial Hospital (AWMH), incurred penalties accumulatively costing the trust HHNFT an additional £123,763.50 to date.

The aims of the team in response to this issue was to identify why staff are incorrectly streaming waste and educate staff to do so correctly. Doing so would align with trust with waste legislation, reduce additional financial costs, and improve the carbon footprint. The team targeted their intervention on pharmaceutical waste as this was the area with the largest impact and potential gain, but the project likely also reached non-pharmaceutical waste.

Intervention:

An initial staff survey revealed staff are confident they can follow the waste management process, and happy that explanatory resources were sufficient. However, most staff answered incorrectly when asked how to dispose of both IV paracetamol bags (63.3% incorrect) and blister packs (60.4% incorrect). The survey was paired with ward walk around conversations that revealed that staff felt waste training was uninteresting, would benefit from in person delivery, and that more signs, posters, and labels, would also be beneficial.

The team developed an interactive game, ‘Bin-Go’, that they toured around the trust’s sites. The game encourages staff to test their knowledge on disposal processes with their teams. Playing along with their colleagues was popular amongst staff, and the campaign was further circulated on social media and through word of mouth. Posters and labels were also designed with bright colours to stand out on busy clinical area walls.

A future initiative is in place to use colour-coded cable ties to identify the clinical area that waste comes from to provide accountability and targeted training in the result of future failed audits.

Outcomes:

• Environmental
  • A total saving of 196 tonnes of co2e per year through proper disposal and reduced incineration – the equivalent to 41,457 miles driven
  • Further reductions are possible by reducing the distance travelled by waste through local Energy Recovery
• Social
  • Strong staff engagement through the game, and enthusiasm with more bins being requested
  • Increased confidence about waste streaming
  • Address patient and public concerns about NHS waste
• Clinical
  • No impact on patient outcomes
• Financial
  • Reduction in fines saving an initial £100,800 per year
  • Energy Recovery can save a further £58,000 in future

Key learning point:

The project identified the main barriers staff faced to not streaming waste properly. These included misunderstanding due to lack of engagement with online training, confusion regarding the waste streams available, and the process of identifying the purpose of each bin. It was particularly valuable to bring the training to staff on the wards and encourage learning through a more relaxed game, rather than through a formal online training module.