Medicine Waste in Care Homes

This project, funded through Q Exchange by the Health Foundation and NHS England, will use the SusQI approach to explore the environmental and social impacts of medicines waste in care homes. We aim to generate innovative solutions in line with CQC environmental sustainability expectations that inspire action across the healthcare system. 

Working with staff in care homes, general practice and pharmacies, we will measure environmental impact, reduce medicine waste, free up staff time, and create guidance and ideas to embed improvements. 

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 this 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: 

1. Environmental – carbon footprint of medicines waste and packaging, pharmaceutical pollution risks. 
2. Social – safety, staff time, local impacts of waste. 
3. 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 the 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. 

Please contact Nuala Hampson, CSH’s Pharmacy Lead and Senior Educator, for more information or if you have any questions.

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