This project was part of the 2023 Green Team Competition at South Warwickshire University NHS Foundation Trust.
The team consisted of two diabetes specialist nurses and two diabetes dietitians.
Millions of people in the UK use single use insulin pens as a key part of their diabetes management. We had 10 weeks to design and implement our project to address this.
Aims of the project
To reduce the environmental impact of insulin pens by:
1) Switching appropriate patients from single use pens to reusable ‘Smart Pens’.
2) Raising awareness of and promoting use of the ‘Pen Cycle’ recycling scheme for single use insulin pens
Studying the system
We reviewed our caseloads and identified 286 patients with ellegble products with a total of 343 prescribed products.
Aim 1 'smart pens'
Methods
We identified patients who could swap from using a single use disposable pen to a reusable pen with a much smaller single use insulin cartridge. The reusable pen lasts for 5 years and is 'smart' as it has the function to give the time since last injection and dose given. We discussed this change with patients in clinics as well as home visits. We also provided training to district nurses on these pens for patients to whom they give insulin.
Patient outcomes
The smart pen provides data to show correct insulin dose was given. In some cases this could reduce district nursing visits whilst knowing insulin is still given as prescribed. This increases independance for patients and enables them to give insulin closer to meal times rather than relying on the district nurses' schedule. Correct insulin doses optimises blood glucose management to help prevent long term complications of diabetes.
Environmental sustainability
Data from the insulin company shows a saving of 6.8 kgCO2e per year for each patient that we switch to reusable pens (based on average insulin use.) Only 29 patients were swapped in the short time frame of the project but if we switched 80% of suitable prescriptions in the next year (274 patients), we could save 1,863.2 kgCO2e per year. Additionally there would be savings from travel from any district nurse visits saved.
Economic sustainability
Some prescriptions have a cost saving associated when swapping from single use pen to insulin cartridge. If we switched 80% of suitable prescriptions in the next year (274 patients), there would be a cost saving of £468.44.
Additionally, based on reducing district nursing visits from twice a day to once a day we could save £23,520 per patient per year.
Aim 2 'PenCycle'
Methods
PenCycle is a project created by the insulin company NovoNordisk. They provide boxes which fit 12 empty single use pens, these are then sent via freepost and travel to a facility in Denmark where the plastic is recycled. We promoted this to district nurses during insulin saftey week and ran a competition of which DN base could collect the most pens.
Patient outcomes
There is no direct impact of PenCycle on patients.
Environmental sustainability
143 pens were collected in 8 weeks by the district nurses. This works out as carbon neutral when comparing disposing in household waste to taking to Denmark. However the saving comes when the plastic is recycled as use of 1 tonne recycled plastic compared to virgin plastic saves on average 780 kgCO2e.
Economic sustainability
NovoNordisk covered the costs of this project as the boxes are supplied and posted at no cost.
Discussion
This project did take time in searching the caseload, writing to GPs to change prescriptions and training district nurses however this was time well invested. Not all patients could have district nursing visits reduced for example if the visit is providing a wider well-being check or if the patient has dexterity or visual issues. The project could be expanded to work with acute teams or those in other geographical locations.
Click here for more information on the Green Team Competition (including organisation impact reports).
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