Reducing the environmental impact of medications in frail patients on Ageing and Complex Medicine ward at WWL

Introduction:

NHS England has set out an ambitious target of delivering the world’s first net zero health service and responding to climate change, improving health now and for future generations. Medicines account for around 25% of emissions from the NHS, from inhalers. anaesthetic and medical gases (5%) and emissions that are embedded in the supply chain of pharmaceuticals (20%). Reducing waste and ensuring appropriate polypharmacy are cornerstones of the NHS strategy to address this, as summarised in the Overprescribing Report.

Method:

The 3 aims of the project were:

1. Improve deprescribing through effective polypharmacy reviews and measure impact on reducing the carbon footprint while ensuring medication is optimised to reduce the risk of harm
2. Assess waste incurred due to medication being supplied to the ward which is not used
3. Engage staff members on the ward with the ambition to make sustainable approach part of routine practice

Results:

Pre-admission and discharge medications were analysed for 20 patients on study ward in pre-intervention phase (September 2024) and post intervention (June 2025). A number of initiatives were completed to highlight risk of inappropriate polypharmacy and encourage proactive deprescribing. Percentage of medication deprescribed increased from -10% to -20% however total number of medication on discharge also increased +21% vs +32% (reflecting multimorbidity) with overall similar figures of +11% and +12%. Significant decrease in anticholinergic effect was observed (+15% to +4%) and 40% vs 43% of deprescribed medication were moderate or high carbon footprint.

Cost of medication wasted approximated £340 per week, implementation of a reuse scheme has potential to save £17,680 per annum and save approximately 3,922 kgCO₂e. There was a high degree of staff engagement, with 90% reporting concern over healthcare impact on the environment.

Conclusions:

Reducing inappropriate polypharmacy, reuse of medication and staff engagement have potential environmental and financial benefits.