Staff education on appropriate medicines waste segregation and use of patient’s own medicines during hospital stay and on discharge

Project completed as part of the 2023-4 Northampton General Hospital NHS Trust Green Team Competition.

Team members

• Janeme Lam, Renal specialist pharmacist
• Shelley Rossiter, Renal ward manager

Setting / patent group: Renal ward

Issue:

There is a high volume of medication returned to the pharmacy team from the renal ward at Northampton General Hospital. While ward staff are often placing medications in a pharmacy return box, believing any medication sent back to pharmacy can be re-dispensed for another patient. This is not always the case. All patient’s own drugs (PODs) and split packs issued by the hospital cannot be returned to be reused due to health and safety recommendations. There are reasons why hospital-supplied medicines may also be unsuitable to re-dispense. All medicines sent back to the pharmacy need to be segregated by the dispensing team. Suitable medications will be returned into the system for re-dispensing, and others will be incinerated as clinical waste. This is an extremely time-consuming process for pharmacy staff. Oversupply of patient’s routine medicines can contribute to pharmaceutical waste. Patients may forget to bring in medication they already have at home, or even if their medications are brought in, ward staff may use hospital supplies to ensure the patient has their own medication on discharge. However – prescriptions will often change during admissions meaning the initial medication brought in is no longer appropriate to take home and needs to be incinerated. All patient medications are often requested on discharge, however if a medication has been unchanged during admission, it is likely the patient doesn’t need those medications to be dispensed by hospital pharmacy – which would save dispensing time. Reduce duplicate supply also helps to reduce unnecessary medicines waste.

Intervention:

The first aim of this project (Task 1) is to reduce dispensary staff time processing medicines returns by providing nurses education on how to segregate patient own drugs (PODs) and hospital-supplied medicines into designated medicines return boxes on the ward. The second aim (Task 2) is to encourage patients to bring their own routine medicines to hospital to reduce the need for hospital dispensing.

Education was provided to ward and pharmacy staff on

• background of sustainability in healthcare
• how much time dispensary staff are currently spending to process medicinal waste from the pharmacy return box
• the process of segregating PODs and hospital-supplied medicinal waste into the designated medicines containers on the ward
• educating nurses to ask patients to bring in PODs, use PODs during hospital stay instead of using ward stock; return PODs to patients on discharge.
• educating pharmacists and pharmacy technicians during the drug history process, to ask patients and their relatives to bring in PODs; for those patients who have brought their medicines to the hospital, to ask patients how much supply they have at home; encourage patients to order PODs from the GP rather than supply from the hospital on discharge; endorse on drug charts that patients can obtain their routine meds from GP.

Outcomes:

On one ward, the combined aims have projected annual savings of £19,680 and 3,435 kgCO2e, equivalent to driving 10,143 miles in an average car.

Socially, 62% of ward staff and 89% pharmacy staff agreed medication waste is a huge problem. Prior to the project dispensing staff expressed frustration at the time spent segregating medications returned from the ward. It is estimated form this project staff will save (2 days) of time in a year for one ward. There are 21 adult wards in NGH. Prior to the project - 100% of pharmacy staff felt there is duplication of dispensing as patients can bring in their medications from home. 50% of ward respondents reported they used patients own medications first rather than ward stock showing room to optimise this. Two patients were surveyed. Both were concerned about the environmental impact of healthcare. Both stated they will only require new medicines on discharge to reduce medicines waste, obtaining medications they were already taking from the GP. Clinically, there is no compromise of patient outcomes by implementing this project.

Although data has not been collected due to time limitations in the project, some potential impacts include

• A reduction in medicines omissions, especially critical medicines by encouraging patients to bring in their PODs to be used in the hospital.
• Discharge medications may be dispensed quicker due to reduction of dispensing items. This will hopefully have a positive patient outcome as patients can go home quicker.

Key learning point

The key elements that contributed to the success of the project include good engagement with the ward pharmacist, nurses, and other pharmacy colleagues. From the staff survey, the majority has raised concerns of medicines waste affecting environmental impact and they want to do something about it. The project has shown by breaking down communication barriers and misconception, multidisciplinary team can work efficiently, cost effectively and environmentally friendly.