Q Exchange
Medicine Waste in Care Homes: Reducing Social and Environmental Impact
- Winning idea
- 2024
Meet the team
Also:
- Deb Gompertz, Complex Care GP and Clinical Lead, South Somerset.
- Ian Clegg, Clinical Pharmacist, Somerset Rural Practice Network.
- Chris Gifkins, Senior Care Home Clinical Pharmacist, NHS Gloucestershire
- Adele Jones, Chief Pharmacist Primary Care & Associate Director, NHS Gloucestershire
- Amandeep Bhandal, Care Home Senior Technician, Coventry/Warwickshire ICB
What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?
Medicine provision to care homes is a complex process requiring regular communication across the interface between care homes, general practice, and community pharmacy. Workload is high; medicines management processes are complex, time consuming and high risk. Sites are physically remote from each other, adding to communication challenges.
Medicines and inhalers comprise 23% of the overall NHS carbon footprint. Approximately £50 million worth of unused medicines are disposed of annually by care homes. The financial cost is well documented; environmental and social impacts are less well understood. Limited accountability for medicines costs, and inefficient interface prescription processes may contribute to the problem of avoidable waste.
We propose using the expertise of the Q community and a collaborative approach between care homes, general practice and community pharmacy to identify and address interface challenges. The focus on environmental and social impacts of avoidable medicines waste re-frames this into a compelling problem urgently requiring solutions.
What does your project aim to achieve?
We aim to:
- Explore the infrastructure, organisational and cultural factors across care homes, general practice and community pharmacies which contribute to avoidable medicines waste, including dressings and nutritional feeds.
- Use SusQI methodology to map existing processes, measure environmental, social and financial impacts, and identify opportunities for sustainable change.
- Generate innovative and implementable solutions, in line with CQC environmental sustainability expectations and NHS net zero targets, that inspire action across the system.
- Generate key recommendations and education resources for the efficient and sustainable management of medicines in care homes.
- Disseminate the learning to care home, general practice and community pharmacy teams via online learning, webinars, conference posters and guidance.
- Engage with integrated care system teams and care home providers to embed learning into staff training.
- Influence change at policy level.
Other anticipated benefits:
- Networking and partnership building across settings, enabling future collaborative work.
- Collaboration between Q community special interest groups.
How will the project be delivered?
We have identified several key collaborators across Integrated Care Systems in England, who will undertake local recruitment of teams, facilitate communication, and support practical aspects of the project locally, such as stakeholder and process mapping. The team at CSH will work closely with care home, general practice and pharmacy teams to:
- Map the medicines pathway across the interface from order through to disposal.
- Measure the environmental, social and financial costs of the medicines pathway:
- Environmental – carbon footprint of medicines waste and packaging, pharmaceutical pollution risks.
- Social – safety, staff time, local impacts of waste.
- Financial – cost of medicines, disposal costs.
- Qualitatively explore knowledge, attitudes and values in relation to safe, efficient, sustainable medicines management.
- Co-create innovative and achievable improvements to the identified challenges across the interface.
- Utilise SusQI methodology to implement and measure the impact of improvement interventions.
- Generate accessible education resources to share learning and influence policy.
How is your project going to share learning?
CSH are leading experts in sustainable healthcare. We have developed education on sustainable specialties and have experience of working with professional bodies and the Q Community to utilise and share knowledge.
We will develop educational resources on sustainable care home medicines management including:
- Insight into the challenges identified
- Data on the environmental impacts of medicines wastage
- Examples of social impacts of medicines wastage
- Key criteria and recommendations for sustainable medicines management across the interface.
- Education materials will be accessible online, and will be shared with:
- Care homes, general practice and pharmacy teams
- The Q community and via relevant specialist interest groups, including Medicines Management, Primary Care and Sustainable Healthcare.
- CSH online networks and incorporated into existing CSH education provision.
- Relevant key primary care organisations, such as Greener Practice and the Primary Care Pharmacy Organisation.
- Organisations who can drive change – Royal Colleges, Care Quality Commission and Five Nations Care Forum.
How you can contribute
- Interested parties - are you interested in being involved?
- Experience - have you undertaken similar work? What was your experience?
- Challenges to look out for
- Insights into working across care home, general practice and community pharmacy interfaces
- Insights from dedicated care home medicines management teams
- Suggestions for scope of the definition of medicines - to include prescribed non-medicine items such as dressings, sip feeds and topical non-medicated products such as emollients.
- Ideas for refining/improving the project
- Links with other SIGs
Plan timeline
| 1 Aug 2024 | CSH and key collaborators: Confirm recruitment of partner sites. |
|---|---|
| 1 Sep 2024 | Online inductions, staff surveys, data collection, process mapping. |
| 1 Dec 2024 | Collate data, identify challenges, measure impacts, co create solutions. |
| 1 Feb 2025 | Implement and test solutions, measure improvements |
| 1 May 2025 | Complete SusQI reports, feedback from sites |
| 1 Jun 2025 | Collate learning, develop resources, share case studies, dissemination, scaling up |
Comments
Evelyn Prodger 28 Jul 2024
Congratulations on winning - really great project and outputs will resonate for other areas such as Hospices but also Community Hospitals .
We have a Community Hospitals SIG on this site - please do join if you think it could be useful to you - I think there will be a lot of interest from my community hospital colleagues on this topic.
Evelyn
Nuala Hampson (she/her) 29 Jul 2024
Thanks, Evelyn, will do!
Nuala Hampson (she/her) 8 Jul 2024
Just wanted to say thank you so much to everyone who commented, provided suggestions and offered support. The process really helped us to refine the project. We are excited to get started!
Nuala
Jo-Anne Wilson 3 Jul 2024
Great news. such an important topic. Look forward to contributing
Sundus Jawad 3 Jul 2024
Well done folks ! So pleased this project has received funding as will have a huge impact.
Wendy Tyler-Batt 12 Jun 2024
Medicines wastage in Care Homes has long been a source of concern, the reasons for which are many & complex. Historically the financial burden to the NHS has been highlighted ; which will continue to grow with our ageing population. But this is only part of the story along with the carbon footprint, brought into focus by the Greener NHS and the target of carbon net zero by 2040/45, and not forgetting pharmaceutical pollution.Tied in with this is the frequency of inappropriate polypharmacy in our elderly and frail population which can impact negatively on quality of life and result in hospital admissions .This well thought out proposal will contribute to our knowledge and help find solutions.
Katrina Davies 11 Jun 2024
This is such an important piece of work. It brings together the two most pressing challenges of our time, frailty and the climate/ecological emergency, both hurtling towards us at speed and needing urgent solutions.
As a GP with experience working in care homes, I welcome any improvement in the process which creates less waste, less damage to the environment and less staff anxiety caused by the complexity in each site, as well as saving NHS resources (staff, time and financial).
The outcomes will be hugely beneficial to the NHS’s commitment to delivering Net Zero by 2040. As 10% of medication is overprescribed annually in the UK, and older people with frailty are the most likely to have been prescribed multiple medications, and also the group most likely to be in care homes, the project results would have a major impact on our ability as clinicians to reduce the primary care carbon footprint significantly (around 60% of the total primary care footprint is medications). Approximately 20% of hospital admissions in over 65 year olds are medication related, around two thirds of which may be preventable, so the project would be likely to reduce the risk of patient harm, the strain on the NHS, and the knock on social impacts for patients and relatives which result from admission. There will be multiple unseen co-benefits resulting from the research which are not listed here.
Thank you for proposing such a vital, comprehensive project. Having worked with some of you on a previous CSH large scale community susQI project on frailty, I have seen your diligence, expertise and commitment as a project team first hand. I sincerely hope you are successful with the funding bid!
Katrina Davies, GP with masters in frailty and integrated care, director of Greener Practice CIC, past co-lead for climate at the British Geriatric Society, current climate rep on the Community and Primary Care Committee, British Geriatric Society.
Clare Knight 11 Jun 2024
An exciting project! I work for Sussex Community NHS Foundation Trust who are commissioned to provide a MOCH service to 15,000 care home residents across the Sussex ICS footprint. We have just completed our first year and have data which represents medicines stopped/ changed/ cost and carbon savings. There are so many processes in primary care which lead to waste. Do get in contact if we can partner with you from our experience of working with about 700 care homes
Clare Knight (Principal pharmacist MOCH B&H & lead pharmacist for research SCFT)
Terry Watkins 11 Jun 2024
This is a very exciting project and one that we will not only watch the progress over the coming months but would welcome any involvement that you feel we could contribute to your team. In Aneurin Bevan University Health Board in South Wales we have a Medicines management programme board which has been very successful over the past few years and welcome any new initiatives looking at efficiency, safety, cost reduction, carbon opportunities & waste within our processes. we can share some of our work if you feel this would help and would also welcome ideas and opportunities to work collaboratively with your team.
Kind Regards
Terry Watkins (Senior Programme Manager - Planning & PMO)
Nuala Hampson (she/her) 11 Jun 2024
Hi Terry
thank you for your comments and offer to share work. It will be useful to hear of your experience and see how that can feed into our project plan. Please do keep in touch! nuala.hampson@sustainablehealthcare.org.uk
Nuala
Constantinos Regas 9 Jun 2024
This is a really interesting project.
Perhaps it's worth linking in with the openprescribing team in Oxford, either for data or for building indicators? (Here's an example on inhalers)
Constantinos
Catherine Richards 10 Jun 2024
Great idea Constantinos, we're currently doing some work in North East London within Primary Care and medicines optimisation and have been using Open Prescribing. So often deprescribing initiatives and work aren't well linked to sustainability, so would be great if this can be developed more!
Nuala Hampson (she/her) 10 Jun 2024
Thank you Constantinos, that is a really good suggestion. I know that the Open Prescribing team are always looking for new suggestions for prescribing measures and are also keen to expand their range of measures on "green prescribing". It will certainly be useful to feed our findings into their team. Thank you for the suggestion!
Nuala
Minna Eii 31 May 2024
I am just about to present my care home medicines waste audit findings for 2 south east London care homes with the care home staff and discuss how we could take things forward with key stakeholders collaboratively. Will share more information when the project is concluded. Great project - lots of potential cost and carbon savings!
Nuala Hampson (she/her) 3 Jun 2024
Thanks Minna
that would be really helpful. Our earlier conversations were really helpful in understanding the challenges faced!
Nuala
Jo-Anne Wilson 29 May 2024
This is a fabulous project and something we are looking at as part of our 'Green team' work. We are a large care home in Warwickshire and would love to be involved. I am trying to champion waste around end of life medication in particular. During Covid we used the 'reuse of medication' guidance that was issued by the government but that has since been withdrawn. We are regularly throwing away, on one hand, medication that we are searching for on the other! We are working to reduce wastage with our community pharmacist by medication reviews and reduction in prescribing, only ordering what is required.
Nuala Hampson (she/her) 29 May 2024
Hi Jo-Anne,
thanks for your message - would definitely be interested in chatting further. We are already in contact with Amandeep Bhandal, pharmacy technician, Coventry and Warwickshire ICS. She has already shared some really useful guidance from your region. It would be great to connect.
You've mentioned end of life medicine; what is your approach for PRN meds, topical creams, dressings, sip feeds etc?
Nuala (nuala.hampson@sustainablehealthcare.org.uk)
sharon pfleger 29 May 2024
Hi Nuala, thanks for sharing, looks great. Is this an NHSE / Q community only project? I work with a pharmacist who wants to investigate care home waste in Inverness-shire and we'd be up for collaborating.
Nuala Hampson (she/her) 29 May 2024
Hi Sharon
thanks for your interest. The approach we are planning on using is the CSH SusQI approach, so no reason why this couldn't be duplicated in another region. It would be interesting to collate and compare findings. Let's keep in touch.
Nuala
Sarah Garland 23 May 2024
Enteral feeds and oral nutritional supplements are prescription items that are also often wasted. There is a national network of prescribing support Dietitians with experience in this area.
Nuala Hampson (she/her) 23 May 2024
Hi Sarah,
can you connect me up with the dietician network? I would be interested in their insight in to the issue of waste of nutritional feeds and indeed the need for prescribed oral feeds in the first place in the care home setting.
Nuala
Frances Mortimer 23 May 2024
Thanks so much Sarah. We want to include oral nutritional supplements and other items such as dressings and PRN topical items like creams and ointment as these are often the things that get over-ordered and wasted. Will refine our scope to ensure that it is clear that these are included.
Would be very interested to hear insights from the dietician group also.
Nuala
Frances Mortimer 23 May 2024
That's a really good point, thanks, Sarah. We will have a look at whether we can bring nutritional supplements into scope for the project.
Frances Mortimer 20 Mar 2024
Thank you to the Q Community for all your interest and useful suggestions! You have helped us to identify a number of teams in ICSs around the country who are interested in being involved. The issue of medicines waste in care homes is something which many people have commented on as being a significant and ongoing problem. We hope that working across system boundaries and identifying environmental impacts provide a fresh focus to address a long standing problem.
sundus jawad 18 Mar 2024
Great idea!
This is so important from a patient, cost and sustainability perspective but also exploring potential solutions.
Do consider exploring 'medicines re-use' of sealed un-opened medication as a possible solution. So much waste also could be prevented is medication that is not needed isn't ordered in the first place!
Good luck and happy to help if needed.
Sundus Jawad, ICS Lead Medicines Optimisation Care Homes Pharmacist, NHS Frimley, sundus.jawad@nhs.net
Frances Mortimer 20 Mar 2024
Thanks so much for these points and offer of help, Sundus! Will definitely be following up with you!
Nuala Hampson (she/her) 19 Mar 2024
Thanks, Sundus, we will certainly be aiming to reduce unnecessary ordering in the first place. In terms of reuse in the community setting, my understanding is that dispensed medicines, once they has left the pharmacy cannot be reused. A possible alternative for PRN medicines is to order as "bulk" (PRN items which can be used by multiple patients) rather than named prescriptions to reduce waste. I know in hospitals, unopened medicines can be redispensed as the storage conditions are guaranteed as they haven't left the hospital. Do let me know if I am missing something!
Thanks for sharing your e-mail address, I will be in touch as eager to pick up on any existing learning / tips.
Nuala
Clare Daly 12 Mar 2024
It sounds like a very interesting project. The Clinical Research Network (CRN) have great links to your stakeholders- care homes/ community pharmacy/ GPs and others. If your project is adopted onto the portfolio they would be a very valuable source of support. Happy to be contacted for more information. Clare.daly@nihr.ac.uk-Community Pharmacy lead, East of England CRN.
Frances Mortimer 20 Mar 2024
Thank you, Clare!
Nuala Hampson (she/her) 12 Mar 2024
Thanks, Clare! I will be in touch.
Nadine Payne 4 Mar 2024
Great idea! We started a similar journey in Salford a few years ago, supporting a local Meds Op QI project to develop a Care Homes Medicines Audit tool and process, with a Pharmacist embedded in the service to lead on this. This really improved local processes and was instrumental in supporting improved CQC ratings for homes locally. We're about 4/5 years into this now, and have a mature audit tool and process and this pharmacy role solidified into our Neighbourhoods Pharmacists team linked to the Care Homes GP Practice.
If it would be helpful, I'd be happy to link you to the QI lead in the neighbourhoods pharmacists team in Salford? I know they would be very happy to share any of our work that might be helpful here
Nuala Hampson (she/her) 23 May 2024
Hi Nadine,
Can I pick up again on your offer of collaboration? I'd be very interested to learn from your experience. Could you drop me an e-mail to nuala.hampson@sustainablehealthcare.org.uk or if there are any published materials in relation to your work, please do signpost me .
Many thanks
Nuala
Frances Mortimer 20 Mar 2024
Absolutely keen to learn from / build on this work, thank you Nadine. Great to hear it has been going on.
Nuala Hampson (she/her) 4 Mar 2024
Hi Nadine,
yes please, do link me in, that would be very helpful.
nuala.hampson@sustainablehealthcare.org.uk
Many thanks
Nuala
Laura Keel 29 Feb 2024
I really like this project - I wondered a little about dressings and prescribers such a community nurses being brought into the fold?
Perhaps this is a wider remit and I absolutely appreciate how a QI project can grow arms and legs! We have found in some of our QI work that supporting the community nurse prescribers (who see patients in care homes) to stick to the formulary is quite a challenge; so engaging with this group and creating digital resources for them when out and about has received great feedback.
Good luck in your endeavours.
Nuala Hampson (she/her) 4 Mar 2024
Hi Laura
thank you for that suggestion. One of our first aims will be to identify commonly wasted items. I think you are right in that dressings are likely to be amongst these and will definitely be an aspect that we will consider. It will be interesting to explore the process for prescribing these in different settings / regions.
Nuala
Deb Gompertz 27 Feb 2024
Looks like a really interesting project on a very important problem to tackle. Not only looking at care for people but importantly the cost to the NHS and the cost to the environment as well. I like the idea that this could improve relationships across community pharmacists and primary care to become a proactive way of getting upstream to tackle waste and the issued identified.
Nuala Hampson (she/her) 28 Feb 2024
Thanks, Deb, it was really useful to chat to you to get your perspective. Thank you for sharing your experience of tackling medicines waste in the "show me your medicines" project.
I look forward to further collaboration!
Nuala
Sam Angelo 27 Feb 2024
This sounds amazing! Care home support is so important and I love the sustainability aspect. Keep us at Surrey Heartlands informed and let us know if you need help.
Nuala Hampson (she/her) 28 Feb 2024
Thanks so much, Sam!
Evelyn Prodger 26 Feb 2024
Hi,
I think this is a really important piece of work from a patient, cost and sustainability perspective.
End of life and Just in Case medication will be part of what you will look at I suspect so consider involving hospice in your stakeholders.
Commissioners may be good to engage as they can often identify key people to engage and unblock within the system.
Good luck with this bid - would be so applicable nationally.
Frances Mortimer 20 Mar 2024
Thanks Evelyn. The point about end of life care is making me think that there may be opportunities to link up with another project we are supporting, in an oncology centre, looking at encouraging use of tablet rather than liquid opioids (as having lower carbon footprint), where clinically appropriate.
Nuala Hampson (she/her) 27 Feb 2024
Thank you Evelyn. I think mapping out the stakeholders will be a really vital part of our preparation for this work. Thanks for raising the point about end of life - this will indeed be very relevant.
Nuala
Nadja van Ginneken 24 Feb 2024
I think this is a very important piece of work. I am impressed with although breath of what is trying to be achieved in a short time.
The first objectives of carbon foot printing and understanding the issues are crucial. However, the following two objectives are also very important and I have some comments relating to these:
“- Generate innovative and implementable solutions that inspire people to take action at all levels of the system
- Generate key criteria for the sustainable management of medicines in care homes.”
I realise you are proposing qualitative work with staff as well as workshops. However it is not clear to me how the generation of ideas will lead to solutions, nor exactly who is involved in these. Are staff/families/ directors involved in a co-creation of ideas (not just identifying barriers/opportunities). Using action research methods and consultations with more PPI engagement and ground staff engagement would help take account of ground realities and engagement of staff and families in both determine what change is to be made and in making those changes.
Well done and happy to discuss further comments.
Nadja van Ginneken (GP Liverpool , sustainability lead Central Liverpool PCN, honorary clinical research fellow Univ. of Liverpool)
Nuala Hampson (she/her) 23 May 2024
Hi Nadja
our project has been shortlisted for the next round and I would be really to pick up on your suggestions in relation to co-design experience or specific techniques that you have found simple and effective in this type of work.
Please do feel free to drop me an e-mail at nuala.hampson@sustainablehelathcare.org.uk
Many thanks
Nuala
Frances Mortimer 20 Mar 2024
Thanks for this Nadja, the practicalities of co-design are important and we are definitely keen to learn from processes that have worked well for others.
The SusQI methodology includes studying the system as it works currently - so we will be inviting staff to help us with describing this and sharing information with them about the environmental, social and cost impacts of different steps within the process. We will invite them to share their ideas for improvements but you are right these will need to be reviewed, prioritised and refined through further rounds of engagement.
Do, please, share any co-design experience or specific techniques that you have found simple and effective.
Thank you so much,
Frances
Nuala Hampson (she/her) 26 Feb 2024
Hi Nadja
thank you for your comments and helpful suggestion. Yes we are definitely planning on engaging staff from care homes, general practice and community pharmacy in the co-creation of solutions. We really need to address the interface issues within this and provide an opportunity for staff from these three settings to share the challenges and hopefully come up with solutions which will take into account the whole system, rather than just their own individual setting. We are hoping that doing this via the lens of sustainability will provide a new focus to the age old problem of medicines waste in care homes.
Thanks!
Nuala
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