Q Exchange
Medicine Waste in Care Homes: Reducing Social and Environmental Impact
- Proposal
- 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 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.
- Use the SusQI framework to measure environmental, social and financial costs of medicines waste.
- Generate innovative and implementable solutions, in line with CQC environmental sustainability expectations and NHS net zero targets, that inspire action across the system.
- Test solutions and measure impacts across the interface using SusQI methodology.
- 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 ICS and care home providers to embed learning into staff training.
- Use learning to 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 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
- Reactions - is this project useful?
- 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
- 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
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
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)
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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