Environmentally sustainable opportunities for health systems: metered-dose inhaler prescribing, dispensing, usage, and waste at The Ottawa Hospital
Background: The carbon footprint of Canada's health sector is among the worst in the world, responsible for 4·6% of Canada's total greenhouse gas emissions. A quarter of emissions from Canada's health sector are linked to pharmaceuticals, including metered dose inhalers (MDIs). MDIs u...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-04-01
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| Series: | The Lancet Planetary Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2542519624000706 |
| _version_ | 1827279067713372160 |
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| author | Carolanne Caron, BSc Shellyza Sajwani, MPharm Katherine Bateman, BScPharm Owen Degenhardt, BScPharm Mathilde Gaudreau-Simard, MD Smita Pakhale, MD Salmaan Kanji, PharmD |
| author_facet | Carolanne Caron, BSc Shellyza Sajwani, MPharm Katherine Bateman, BScPharm Owen Degenhardt, BScPharm Mathilde Gaudreau-Simard, MD Smita Pakhale, MD Salmaan Kanji, PharmD |
| author_sort | Carolanne Caron, BSc |
| collection | DOAJ |
| description | Background: The carbon footprint of Canada's health sector is among the worst in the world, responsible for 4·6% of Canada's total greenhouse gas emissions. A quarter of emissions from Canada's health sector are linked to pharmaceuticals, including metered dose inhalers (MDIs). MDIs use propellants, such as hydrofluorocarbons, which act as greenhouse gas emissions and contribute to the health-care sector's overall carbon footprint. The objective of this study was to describe MDI prescribing, dispensing, usage, and waste patterns at The Ottawa Hospital (Ottawa, ON, Canada). Secondary objectives included estimating the monetary and carbon cost of current practice and the potential benefits and costs of switching to the more environmentally friendly dry powder inhalers. Methods: In this retrospective point-prevalence cohort study, we identified 100 consecutive patients from medical and surgical services at both campuses of The Ottawa Hospital from health records discharged from medical and surgical services and who were prescribed at least one MDI during their admission. Medical records were reviewed and data related to demographics, MDI prescribing, dispensing, usage, and wastage were collected using a pre-piloted electronic case report form. Financial cost was calculated using local costing estimates and carbon cost was calculated using published estimates. Findings: Between Jan 1, 2023, and June 1, 2023, we collected data for 100 eligible patients, of whom 60 (60%) were female and 90 (90%) were admitted to hospital medicine wards (10% from surgical wards). The median length of stay was 7 (range 1–47) days. The most common inpatient diagnoses were respiratory tract infections in 43 (43%) of 100 patients and chronic obstructive pulmonary disease exacerbations in 28 (28%) of 100 patients. The median number of MDIs prescribed during a patients stay was two (range one to 15) and the median number dispensed was one (range one to seven). For formulary options of MDIs, of the 200 (range 30–1400) actuations dispensed per patient, 8% were used, representing 92% wastage. During the audit, 315 MDIs were dispensed in total, of which 97 were not used at all. Interpretation: MDIs are significant contributors to the carbon footprint attributed to pharmaceutical use in hospitals. This study suggests that 90% of MDI doses are wasted, showing that there is substantial room for improvement. Funding: None. |
| first_indexed | 2024-04-24T08:13:00Z |
| format | Article |
| id | doaj.art-89a45fd7c9d04fa3895710b38eef6d74 |
| institution | Directory Open Access Journal |
| issn | 2542-5196 |
| language | English |
| last_indexed | 2024-04-24T08:13:00Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Planetary Health |
| spelling | doaj.art-89a45fd7c9d04fa3895710b38eef6d742024-04-17T04:49:42ZengElsevierThe Lancet Planetary Health2542-51962024-04-018S5Environmentally sustainable opportunities for health systems: metered-dose inhaler prescribing, dispensing, usage, and waste at The Ottawa HospitalCarolanne Caron, BSc0Shellyza Sajwani, MPharm1Katherine Bateman, BScPharm2Owen Degenhardt, BScPharm3Mathilde Gaudreau-Simard, MD4Smita Pakhale, MD5Salmaan Kanji, PharmD6Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada; Départment de Pharmacie, Hôpital Monfort, Ottawa, ON, Canada; Correspondence to: Carolanne Caron, Department of Pharmacy, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON K1H 8L6, CanadaDepartment of Pharmacy, The Ottawa Hospital, Ottawa, ON, CanadaDepartment of Pharmacy, The Ottawa Hospital, Ottawa, ON, CanadaDepartment of Pharmacy, The Ottawa Hospital, Ottawa, ON, CanadaDepartment of Medicine, The Ottawa Hospital, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, CanadaDepartment of Respirology, The Ottawa Hospital, Ottawa, ON, CanadaDepartment of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, CanadaBackground: The carbon footprint of Canada's health sector is among the worst in the world, responsible for 4·6% of Canada's total greenhouse gas emissions. A quarter of emissions from Canada's health sector are linked to pharmaceuticals, including metered dose inhalers (MDIs). MDIs use propellants, such as hydrofluorocarbons, which act as greenhouse gas emissions and contribute to the health-care sector's overall carbon footprint. The objective of this study was to describe MDI prescribing, dispensing, usage, and waste patterns at The Ottawa Hospital (Ottawa, ON, Canada). Secondary objectives included estimating the monetary and carbon cost of current practice and the potential benefits and costs of switching to the more environmentally friendly dry powder inhalers. Methods: In this retrospective point-prevalence cohort study, we identified 100 consecutive patients from medical and surgical services at both campuses of The Ottawa Hospital from health records discharged from medical and surgical services and who were prescribed at least one MDI during their admission. Medical records were reviewed and data related to demographics, MDI prescribing, dispensing, usage, and wastage were collected using a pre-piloted electronic case report form. Financial cost was calculated using local costing estimates and carbon cost was calculated using published estimates. Findings: Between Jan 1, 2023, and June 1, 2023, we collected data for 100 eligible patients, of whom 60 (60%) were female and 90 (90%) were admitted to hospital medicine wards (10% from surgical wards). The median length of stay was 7 (range 1–47) days. The most common inpatient diagnoses were respiratory tract infections in 43 (43%) of 100 patients and chronic obstructive pulmonary disease exacerbations in 28 (28%) of 100 patients. The median number of MDIs prescribed during a patients stay was two (range one to 15) and the median number dispensed was one (range one to seven). For formulary options of MDIs, of the 200 (range 30–1400) actuations dispensed per patient, 8% were used, representing 92% wastage. During the audit, 315 MDIs were dispensed in total, of which 97 were not used at all. Interpretation: MDIs are significant contributors to the carbon footprint attributed to pharmaceutical use in hospitals. This study suggests that 90% of MDI doses are wasted, showing that there is substantial room for improvement. Funding: None.http://www.sciencedirect.com/science/article/pii/S2542519624000706 |
| spellingShingle | Carolanne Caron, BSc Shellyza Sajwani, MPharm Katherine Bateman, BScPharm Owen Degenhardt, BScPharm Mathilde Gaudreau-Simard, MD Smita Pakhale, MD Salmaan Kanji, PharmD Environmentally sustainable opportunities for health systems: metered-dose inhaler prescribing, dispensing, usage, and waste at The Ottawa Hospital The Lancet Planetary Health |
| title | Environmentally sustainable opportunities for health systems: metered-dose inhaler prescribing, dispensing, usage, and waste at The Ottawa Hospital |
| title_full | Environmentally sustainable opportunities for health systems: metered-dose inhaler prescribing, dispensing, usage, and waste at The Ottawa Hospital |
| title_fullStr | Environmentally sustainable opportunities for health systems: metered-dose inhaler prescribing, dispensing, usage, and waste at The Ottawa Hospital |
| title_full_unstemmed | Environmentally sustainable opportunities for health systems: metered-dose inhaler prescribing, dispensing, usage, and waste at The Ottawa Hospital |
| title_short | Environmentally sustainable opportunities for health systems: metered-dose inhaler prescribing, dispensing, usage, and waste at The Ottawa Hospital |
| title_sort | environmentally sustainable opportunities for health systems metered dose inhaler prescribing dispensing usage and waste at the ottawa hospital |
| url | http://www.sciencedirect.com/science/article/pii/S2542519624000706 |
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