SusQI Project - Turning Blue Inhalers Green - High Quality Low Carbon Asthma Care

Project completed as part of The SFERIC Programme, a Sustainability Fellowship for Engagement, Research, Innovation and Coordination.

Project Lead: Jackie Reynolds, Pharmacist Prescriber at Oakfield St Surgery and Medicines Management Primary Care Respiratory Lead Pharmacist Aneurin Bevan University Health Board

Project commenced in April 2022 and took place in collaboration with practice staff at Oakfield St Surgery.

Aims:

• Raise awareness of sustainable respiratory care, in particular SABA over-reliance, through delivering education sessions to staff members
• Increase engagement of the practice team through PDSA cycles
• Through SUSQI, reduce the number of asthma patients having three or more SABA inhalers per year by improving diagnosis, optimising medication in line with NHS Wales Asthma Guidelines and reducing over-ordering by removing SABA from repeat
• Reduce the total carbon footprint of inhalers through medicines optimisation and preferentially prescribing inhalers with a lower global warming potential

Outcomes as of February 2023.

Patient and clinical outcomes:

The number of patients having 3 or more SABA inhalers is decreasing, with the percentage prescribed reducing from 43% to 30% from April 2022 to October 2022. This reduction is a marker of positive clinical outcomes, of positive clinical outcomes, with patients on 3 or more SABA inhalers in the last 12 months being associated with worse asthma outcomes than those on less than 3.

Two patients showed a clinically significant 10-point increase in ACT score, following a change in therapy from preventer with separate SABA to maintenance and reliever therapy (MART) in a single inhaler device. Following an asthma review and having treatment optimised to MART therapy one patient commented, ‘’I didn’t realise how bad my asthma was, since starting my new inhaler, I’m no longer waking up at night coughing.’’

Environmental sustainability:

Carbon savings obtained from the NHS Wales decarbonisation dashboard (SPIRA - Decarbonisation Dashboard, accessible to NHS Wales network users only) demonstrate a 28% or 18,823 kgCO2e reduction in the carbon footprint of SABA inhalers when comparing 6 month data from Q2/Q3 (April to September) 2022 with the Q2/Q3 2021. This includes reduction due to reduced SABA items, reductions relating to any SABA MDI switched to DPI and reductions due to SABA MDI being switched to lower GWP SABA MDI e.g. Ventolin to Salamol. Projected across a year, this is a saving of 37,646 kgCO2e, equivalent to driving 108,427 miles in an average car

Economic sustainability:

Comparing Q2/Q3 2022 to the same period in the previous year, the practice has reduced SABA prescribing by 156 items (5%), equating to a prescribing budget saving of £649 (source Caspa data). Projected across a year, this is a potential saving of £1, 298.

Social sustainability:

Feedback from patients having the initial telephone call was positive with most commenting they were unaware of the environmental issues and did not know about returning used / unwanted or expired inhalers to pharmacy for safe disposal. Most were also happy to change to lower carbon alternatives following the discussion.

To read more information see attached full report.

The SFERIC Programme

CSH has partnered with NHS Wales Shared Services Partnership, Cardiff and Vale UHB, the Green Health Wales Network and the Dragon's Heart Institute to offer a 12-month scholarship programme focused on sustainable healthcare procurement. You can learn more about The SFERIC Programme here.