Draft patient leaflet on Green Nephrology - comments invited!

Members of the Green Nephrology Network have been collaborating with the National Kidney Federation to develop an information leaflet for patients about Green Nephrology. The leaflet is to be published in March and the full draft text is available to download here.

Please help us to make it as useful and easy to read as possible: post your suggestions for improvements in the Green Nephrology Forum (make sure that you are logged in, and then use the comment box at the bottom of this page) - by Tuesday 24th February.

In particular, we would value any suggestions on the section on what kidney patients and carers can do to support Green Nephrology, copied below.

Thank you!

Frances

Dr. Frances Mortimer, Medical Director, Centre for Sustainable Healthcare

DRAFT TEXT [ONE SECTION ONLY]:

What can kidney patients and carers do to support Green Nephrology?

There are lots of things that patients and carers can do to help! Here are a few ideas for you to think about – we would encourage you to try those that seem most practical for you:

Save energy – switch off lights when no longer needed. Turn heating down before you open the windows (not always possible in hospital!)

Save medicines – drugs have a high carbon footprint but, nationally, a significant proportion of the drugs that are dispensed are not used. When ordering repeat prescriptions, try to include only the drugs you need, and if you have concerns about taking any of your prescribed medications, discuss them with your doctor, don’t stockpile! Return out-of-date or unused medicines to the pharmacy for correct disposal.

Recycle packaging – paper and plastic packaging can be saved and recycled: at home, and increasingly on kidney units too. For people on home dialysis, suppliers may be able to collect boxes and packaging for recycling when they deliver the next batch.

Save fuel – depending on your health and where you live, there may be opportunities to travel to appointments by public transport, walking or cycling.

Look after your health – eating carefully, taking exercise and keeping an eye on your blood pressure will help you to stay as healthy as possible. It is also important to understand your kidney condition, to know what to look out for and how to seek help promptly if you are worried.

Make use of PatientView – through the PatientView website you can access your own blood test results from home, without waiting for your next appointment. Many patients find this helpful and are able to take a greater part in managing their condition.

Ask questions – many kidney units are already taking steps to improve sustainability, but there is much more to do! It can make a big difference to know that patients are concerned about environmental issues. Here are some questions that you might ask on your unit:

Does the unit have a Green Nephrology staff representative?
Are staff using the correct bins? (only hazardous / infectious waste should be going into the orange bins for incineration)
Can the unit offer telephone appointments?

Comments (15)

Chiew Kong • 9 years ago

Should saving water be included ? Water wastage is rife and I am sure that this should be curbed.

Frances Mortimer • 9 years ago

Thank you - good point. We could include water in the questions for patients to ask of their local unit, e.g. "Does the unit recycle reject water from the RO purification process?"

Or do you think we should include a suggestion for water saving by patients themselves? If so, what would that be?

Frances

Gerry Boyle • 9 years ago

Sadly the subject of water recovery from Renal Units, particularly reject from Water Plant, is not as simple as it might seem. We can split types of water plant into those that use chemicals for disinfection and those that use heat. Water treatment systems that use chemicals create a complexity and risk that might make it uneconomic to recover reject water from this type of plant. Those that use heat do not carry that risk. However both types of system, having removed all chemicals such as chlorine, produce reject water that has no bacteria inhibition. Consequently, even to use such water as 'grey' water for toilet flushes, require a chemical dosing system that costs money, creates risk, and adds a complexity to the whole system that I think needs to be fully assessed as it may be counter productive to any green policy. Only if we can overcome these challenges should we seriously look on water recovery, in this circumstance, as desirable. Gerry

Frances Mortimer • 9 years ago

Thanks for your clarifications Gerry. Would it allay your concerns if we altered the wording in the patient leaflet to suggest that they ask "has the unit investigated the potential for waste water recovery?"

Frances

Chris Stait • 9 years ago

Can we also consider Home Heamo Dialysis waste water... Fillling up garden water tanks , car washing etc. As more people are able to undertake Dialysis at home we should prepare green guidance in a DIY way too. I know , I did it for a year and you realy understand waste close up !!

Gerry Boyle • 9 years ago

That sounds good. I'm not against water recovery, I just think that, much like the recycling processes we have with our councils, it is perhaps not as green as it could be and is in some cases counter productive. So long as it is rationally thought through then it has my support. Cheers, Gerry

Chiew Kong • 9 years ago

I was thinking more of wastage at home rather than recycling reject water. Taps left running (while brushing your teeth, say) without any thought of good clean water being wasted comes to mind. If we are going to tell people to switch off lights, then saving water could be added to the list. It costs money and energy to clean that water in the first place.

Kalpesh Shah • 9 years ago

Water recycling and recovery solutions need to be carefullly thought through and not simply a tick box. Any savings must be easily quantifiable. I constantly get asked about designing systems that will reuse water for toilet flushing but this is not really a good use of recycled water.

A better exampe of water reuse was recently implemented at the Kent and Canterbury Hospital Renal Unit. They were using about 14 million litres of mains water everyyear, which is about 3,500m3 per quarter. I installed a system to collect the waste water from the water treatment sysem and put this straight back in to the front end.

In the three months following commissioning of the system, their mains water usage had fallen to 2,700m3 per quarter giving a projected annual saving ofmore than 3,200m3. The savings in mains water together with the reduced salt consumption projected a payback of 3½ years and the complete water recovery system now reduces their annual carbon footprint by 1.5 tonnes CO2 equivalent.”

Frances Mortimer • 9 years ago

Thank you Kalpesh. Great to hear about the water recovery in Canterbury, and clearly not a tickbox issue - only treated as such here because the leaflet is aimed at patients and gives a brief overview rather than technical details. The Green Nephrology Advisory Group is currently exploring the possibility of producing a Sustainable Unit Guide, which would be a good place to cover this sort of issue in detail. Will keep you posted and will certainly need input from everyone if and when it happens.

Frances

Robert Price • 9 years ago

I am glad to see my HDU (Oxford) recycling paper. They have looked at recycling water with the same results as previous callers. I dialyse at home. When I lived in a house, I applied and received a larger green recycling bin from the council to put my packaging and boxes in, although there was nothing on the packaging to indicate if it was recyclable. I now live in a flat where communal recycling space is at a premium. I am waiting for someone to make a complaint.

Bob Price

Frances Mortimer • 9 years ago

Many thanks to everyone who sent suggestions both on- and offline, it has been extremely useful. The draft text for the patient leaflet has been revised and can be downloaded here: http://sustainablehealthcare.org.uk/green-nephrology/resources/2015/02/patient-leaflet-draft-comments

The working group is currently reviewing layout and images. The plan is that the leaflet will be available by the end of March 2015 - to download from this website, or in hard copy from the NKF.

Best wishes,

Frances

James Warham • 9 years ago

As a home heamo patient, I try to reuse, or recycle as much packaging as possible.

Boxes, esp those for dialysers, saline, blood pumps and put on packs have huge potential for secondary use before recycling.

I've given a number of boxes away via the Freecycle/Freegle network, to those needing them for moving, school projects, weed control. We've even used one as a temporary hive for bee transportation. While hospitals, and waste disposale companies have to reach targets, home patients have the option for secondary use or precycleing of some packaging.

Hopefully.

On the topic of water I would think that even home dialysis water could be recycled in the priming, and treatment stages, with only the chemical or citric causing a higer risk of contamination to waste water.. Do correct me if this is wrong.

James

Gerry Boyle • 9 years ago

Hi James, fantastic job regarding re and precycling packing material. A little bit more complicated regarding water recovery at home. I cannot see how the output from the dialysis machine could be recycled in any way due to the very high level of salt in the water. However, there is no reason why the reject from the RO could not be used in the same way as recovered rainwater. The same conditions regarding citric acid or any other chemicals used to clean or disinfect the RO would apply but this could easily be dealt with. RO that uses heat to disinfect RO membrane would make this quite achievable. Given that upwards of 30% of the water fed into the RO is sent to drain then this would be a significant saving. Anyone running such a project care to coment? Regards, Gerry

Ben Wilson • 9 years ago

On the same theme as James regarding the recycling of cardboard boxes. We save up the boxes from our 'Artis-Sets' dialysis lines and a local removals man collects them on a weekly basis. Its not something we've run by the trust but it suits us and the removals man (saves us a trip to the communal recycling area and it saves him the expense of buying boxes!). It may be something others could try- its certainly worth ringing any removals companies or your local man-with-a-van to see if they can make use of them

Frances Mortimer • 9 years ago

Thanks for all the really helpful input to the Green Nephrology patient leaflet. This has now been finalised and can be downloaded from here.

Best wishes,

Frances

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