Case Studies, Blogs, & Useful Links

Case Studies

Case Study #1 - Recycling Blister Packets

The majority of tablets and capsules must be stored in blister packets, specifically designed to avoid crushing or damage and to protect medicines from external elements such as water or humidity.

While blister packets are important to preserve the safety and effectiveness of the medicine, their composition means that their recycling is a complex process that requires specialist treatment. Blister packets therefore are inappropriate for household recycling and are typically destined for landfills.

In 2020 Terracycle, an organisation that specialises in the reuse of non-recyclable post-consumer waste, launched a new scheme aimed to overcome the challenges of blister packet recycling. As part of the Medicine Packet Recycling Programme, the public can drop off empty medicine blister packets to a participating pharmacy, who will then arrange for appropriate recycling with Terracycle. The empty blister packs will then be cleaned and separated into different polymer types. The material is then extruded into plastic pellets to make newly recycled products.

Find out more:

See also our policy on Tackling Medicines Waste

Case Study #2 - Inhaler Recycling

Landfill disposal of inhalers is particularly harmful for the environment. This is not only due to the plastic that is not recycled, but is also a consequence to the greenhouse gasses released into the atmosphere from the residual gas left canisters. If every inhaler-user in the UK returned all their inhalers for one year, this could save 512,330 tonnes of CO 2eq - the same as a VW Golf car being driven around the world 88,606 times.1

In order to grow the opportunities for inhaler recycling, pharmaceutical company Chiesi have launched the UK’s first postal inhaler recycling scheme in Leicestershire. The ongoing pilot allows patients to recycle any brand or type of inhaler by posting them using a pre-paid envelope. Once returned, any propellant gas remaining in the cannister, it is extracted and reused in fridges or air conditioning units. Meanwhile, the aluminium cannisters are recycled and reused, while the plastic is recycled. If there are any non-recyclable materials they are converted into energy.

The scheme complements the waste collection service already available within community pharmacies and is particularly useful for patients who may be housebound or do not regularly visit a pharmacy in person.

See also our policy on Tackling Medicines Waste


Case Study #3 - Green Theatre Groups

Certain anaesthetic gases used in surgery can have a particularly high carbon footprint, so much so that they amount to 2% of the NHS’s total emissions.

With an aim of reducing emissions from anaesthetic gases, staff at NHS Lothian have established ‘green theatre’ working groups across each acute site. Comprising of members from across the multidisciplinary team including lead pharmacists for theatres, the groups work towards reducing gas usage, minimizing waste, reusing and recycling.

From the groups’ inception in 2019, the volatile footprint has reduced considerably through ongoing investigation and actions on anaesthetic gas mitigation. In total, low-flow anaesthesia and the amount of desflurane use has reduced from 20% of total volatile units (bottles) to less than 5%. As well as leading to more sustainable practice, the groups’ initiatives have also led to cost reductions.

See also our policy on Improving prescribing and medicines use

Case Study #4 - Reducing Use of Nitrous Oxide

Known to be significantly more potent than carbon dioxide, nitrous oxide it is the biggest human-related threat to the ozone layer. While medical use of nitrous oxide is thought to contribute to less than 5% of total global nitrous oxide emissions, given its high potency, reducing its usage can make a real difference.

At NHS Lothian, nitrous oxide consumption was identified to be responsible for at least 80% of their total anaesthetic gas footprint. To tackle this, the pharmacy team undertook a detailed review which found that the majority of the anaesthetic gas footprint was from nitrous oxide manifolds. On further investigation it was determined that theatre use of nitrous oxide was in fact low, but that that supply chain wastage was likely to be the main cause. A multidisciplinary team was then established to develop metrics, collect and review data which included manifold audits in order to better understand usage and which manifold supplied which areas.

The team identified that there was low usage of the gas, poor stock rotations and expired stock, as well as system leakage and wastage. It was decided to reduce nitrous oxide provision and to process map the current system to identify where improvements could be made. This has already resulted in one manifold being immediately decommissioned with a further two under scrutiny for decommission.

See also our policy on Improving prescribing and medicines use

Case Study #5 - Anaesthetic Gases: Banning Desflurane

Until 2019, anaesthetic gases contributed 5% of the carbon footprint of Raigmore Hospital in Inverness. An average day for one anaesthetist released the CO2 equivalent of 4,600km driving. However, following a determined and proactive action from staff across the multidisciplinary team over an 18 month period, an average day now only accounts for about 20km.

This significant reduction was achieved by pursuing three key actions:

  1. Reducing use of Nitrous Oxide
  2. Promoting low-flow anaesthesia where gases are re-circulated
  3. And most importantly, reducing and then effectively banning (making non-stock) Desflurane.

Crucially, replacing Desflurane with Sevoflurane has no impact on patient care and saves about £70,000 per annum recurring for the hospital.

Raigmore was the first and remains one of the few hospitals in the UK to have completely removed this polluting drug. However, a group first established Raigmore, the Scottish Environmental Anaesthesia Group (SEAG), is now co-ordinating efforts to spread the message.

See also our policy on Improving prescribing and medicines use

Case Study #6 - Sustainable Prescription Ordering

With around 25% of NHS carbon emissions coming from medicines, every single unnecessary and wasted prescribed medicine makes progress on reducing health service emissions increasingly difficult. A frequent source of wasted medicines are repeat prescriptions which are automatically ordered but often are not needed.

With 77% of medicines used within Dartford, Gravesham and Swanley (DSG) CSG generated by repeat prescriptions, their medicines optimisation team have prioritising reducing repeat prescribing waste over recent years. They initially implemented a telephone prescription ordering system based across a number of GP practices. It enabled patients to discuss their medicines before a repeat order was requested. It proved to be incredibly successful with prescribing costs falling by £650,000 in the first year.

Building on the initial success, and in order to expand the model across the CSG area, they subsequently introduced an app-based prescription ordering system. The app facilitates repeat prescribing across the local network of community pharmacies and ensures patients are ordering the correct amounts, avoids medicines being stockpiled and reduces waste.

Find out more:

See also our policy on Improving prescribing and medicines use

Case Study #7 - Sustainability in the Workplace

The pharmacy department at the Royal Bournemouth and Christchurch NHS Trust have been passionate about sustainability for over a decade. So much so they have been awarded the Green Impact Award from 2013-2020, each year building upon their previous success, going from Bronze recognition to achieving the Excellence award.

Their success has been down to a few individuals initially championing change, and enthusing others to get involved. 

Some of the changes the department has made includes:

  • Displaying signs reminding people to switch off their computer monitors off and lights
  • Displaying signs by taps of contact details of appropriate personnel to come and manage a leaking taps
  • Using a water heater rather than a kettle
  • Recycling paper and cardboard
  • Recycling plastic (including all wrapping/bubblewrap from deliveries) as well as procuring recycled paper for the department
  • Introducing mixed recycle bins in every office and work/staff area, as well as specific recycle bins for plastic, pens, batteries, temperature monitors, crisp packets, to name a few.

The whole team have fully bought into these simple but far-reaching actions. Not only has the activity helped made the department more environmentally sustainable, but has also brought the staff together for a joint purpose and developed a strong team spirit.

See also our policy on Infrastructure and ways of working

Case Study #8 - Reducing Water Pollution from Medicines

Medicines can have other adverse environmental impacts beyond carbon emissions. One example is pharmaceutical residues entering water bodies and the sewage system. This can occur through human excretion, skin products being washed off or by medicines being flushed down the toilet.

Being aware of the harm of water contamination, the team at Caithness General Hospital in Wick tested the hospital’s waste water for eight commonly used medicines. Seven of which were discovered.

To tackle the problem and reduce the pharmaceutical footprint of the hospital water they adopted a three pronged approach:

  1. To “green” the medicines formulary by adding ‘environmental impact’ as an additional and equal consideration to efficacy, safety and cost-effectiveness
  2. Worked with prescribers and patients to take a “realistic medicine” approach to decision making through patient coproduction and consideration of alternatives to medicine prescription such as social prescribing or lifestyle changes
  3. Communication with the public, focusing on key actions to reduce antimicrobial resistance, to improve understanding of when antibiotics are necessary and the importance of finish a course. This work included the creation of this public information video.

In recognition of this trail-blazing work the hospital was the first in the world to achieve Alliance for Water Stewardship certification.

See also our policy on Tackling Medicines Waste