Medicine Waste in Care Homes

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

Working with staff in care homes, general practice, and pharmacies, we measured environmental impact and identified simple interventions to reduce medicine waste and free up staff time. We have created guidance and case studies to share improvement ideas.

What challenges did your project 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 and communication contribute to the problem of avoidable waste. 

We utilised 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 did this project aim to achieve?

We aimed to: 

• Explore the infrastructure, organisational and cultural factors across care homes, general practice and community pharmacies which contribute to avoidable medicines waste. 
• 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 homes, 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 benefits: 
• Networking and partnership building across settings, enabling future collaborative work. 
• Collaboration between Q community special interest groups. 

How was the project delivered?

We recruited four hubs from across Integrated Care Systems in England. Each hub consisted of a hub lead plus at least one representative from the participating care home, the GP practice that prescribed for that care home and the community pharmacy that dispensed the monthly medicine for that care home. The team at CSH worked 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 delivery, 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. 

What were the key findings of the project?

• Financial: Annual medicine waste per care home ranged from £2,125 to £9,404 (mean £6,619), equivalent to £125 per bed every year.

• Environmental: This wastage carried an average carbon footprint of 3.2 tCO₂e per home, comparable to driving 9,425 petrol-car miles or the equivalent of 335 GP appointments. In one hub, transport emissions from daily medicine deliveries (5.99 tCO₂e/yr) actually exceeded the carbon footprint of the medicine themselves.

• Workforce: Around 46 oral doses were discarded, and 2.5 waste-log entries written every day per care home. Based on conservative estimates of staff timings, staff spent an estimated 155 hours per home each year on disposal of unused medicine alone.

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. As a result of this project, we have developed a range of educational and informative resources on sustainable care home medicines management:

Full project report

This includes:

• An executive summary
• A quick guide to implementing our findings into your service
• Policy recommendations
• A detailed report outlining the aim, methodology, findings and implications of this project

Screencast

Freely available screencast on the issue of medicines waste in the care home pathway (coming soon).

SusQI Showcase presentation

Case studies

A summary of case studies completed as part of the project can be found on the CSH Pharmacy Network.

Health Services Journal article

HSJ commentary on medicines waste

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

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