Pharmaceutical waste is comprised of pharmaceuticals (tablets and capsules), original containers, product inserts such as plastic spoons or measures, and packaging waste. Pharmaceutical and clinical waste may represent up to 8% of a hospital’s waste and exhaust approximately 40% of a hospital’s waste management budget.
It is estimated that 40-60% of waste to clinical waste streams is non-clinical waste, of which substantial amounts are potentially recyclable. Appropriate segregation of waste streams at source (the point of waste generation) can increase the proportion of pharmaceutical waste that is recycled or disposed of as nonclinical waste. In turn, this reduces the proportion sent for incineration, the hospital’s carbon footprint and associated waste management costs.
The blister pack recycling program at Bathurst Hospital aimed to improve pharmaceutical waste management by introducing a ward-based education program increasing staff knowledge, capability, and opportunities to segregate waste.
Increasing staff awareness of pharmaceutical waste
The project team implemented a behavioural change education intervention across Bathurst Hospital, overseen by a project lead with support from nursing unit managers (NUMS) and nurse educators. The project lead, NUMs and clinical nurse educators delivered education to the pharmacy department and nursing staff, focused on increasing staff awareness of pharmaceutical waste, appropriate waste segregation and pharmaceutical waste management.
The team developed educational posters on the different impacts of pharmaceutical waste and placed them in ward treatment rooms, staff communal areas and in the pharmacy department. The team also applied waste segregation message signs to existing ward ‘return to pharmacy’ receptacles.
NUMs and clinical nurse educators presented educational resources at handovers and training over a three-month period. The project team designed educational resources so that the message was brief and consistent, did not require delivery by specialised staff, where possible utilised or built on existing process and was adaptable to a range of situations. A staff survey measured self-reported staff knowledge, attitudes, and behaviour pre- and post- intervention.
The pharmacy department collected the medication blister strips from throughout the facility through existing ‘return to pharmacy’ containers. Recycling progress updates were communicated monthly via email, noticeboards and at handover meetings. Outcome measures included pharmaceutical waste (volume and weight), cost of disposal of pharmaceutical bins and medication strips, estimated carbon emissions saved and staff knowledge, motivation, attitudes, and behaviour.
Improved knowledge of recycling
From November 2022, hospital waste staff recorded the weight of pharmaceutical waste, and then from mid-2023, pharmacy staff collected and recorded weight and volume of blister strips collected for recycling. The team estimated CO2e carbon emissions using a life cycle inventory created using the Ecoinvent Life Cycle Inventory database. Financial costs data for pharma bins were obtained by waste service provider. Costs are charged per bin sent for incineration (22L and 64L). Pharmacycle bins (used for blister strips recycling) were 60L at a cost of $172 per bin.
During the intervention period, there was little or no evidence of changes in pharmaceutical waste volume or costs. It was not possible to audit the bin contents, and bins may have been removed from treatment rooms before they were full.
The project team measured staff knowledge, motivation, attitudes, and behaviour via an anonymous self-report survey before and after the intervention. Survey results showed the education resources and posters raised staff awareness about recycling in their workplace and improved staff knowledge about how to appropriately manage, segregate and dispose of pharmaceutical waste. No relationship between the education intervention and the number or weight of pharmaceutical waste bins sent for incineration from the facility was found.
Potential for future fiancial and carbon savings
If all the medication strips collected for recycling during the intervention (140L) had been placed into pharmaceutical waste bins they would have cost around $250 to incinerate and generated 15kg CO2e. The cost of sending this volume of strips to recycling was around $400 (each 60L blister pack recycling bin cost $170). Therefore, due to the high current cost to hospitals of recycling blister packs, there were no financial benefits and modest carbon savings in this project.
In future, if the blister pack recycling costs could be incorporated into a product stewardship program (so that recycling costs are paid by the pharmaceutical companies producing the products) there could be financial and carbon savings for hospitals. Even without significant improvements in pharmaceutical bin weights and numbers, there remains potential benefit in continuing to segregate pharmaceutical waste, particularly returning items to the pharmacy for disposal. The larger 64L bins, which for security and safety are only used in pharmacy departments, cost much less (around one third) per kg to dispose of pharmaceutical waste than the secure 22L bins in treatment areas.
References
- Hutchins et al., (2009). Coming round to recycling, BMJ 28 March, Vol. 338, pp. 746-748.
- McGain et al., (2009). An audit of intensive care unit recyclable waste, Anaesthesia, Vol 64, pp 1299-1302.
- McGain et al., (2009). An audit of potentially recyclable waste from anaesthetic practice, Anaesthesia and Intensive Care, Vol. 37, No. 5, September, pp. 820-823.
- Runcie, H. (2018). Sort your waste! An audit on the use of clinical waste bins and its implications, Future Healthcare Journal, Vol. 5, No. 3, Oct, pp. 203–206.
