Healthcare systems contribute significantly to greenhouse gas emissions and environmental pollution. Climate change is affecting human health, prompting healthcare professionals to adopt more sustainable practices.
Pharmaceuticals play a major role in healthcare-related emissions, with their supply chain depleting natural resources and contributing to global warming. Medication waste not only incurs unnecessary costs but also pollutes water systems and increases antibiotic resistance.
Efforts to reduce pharmaceutical waste include optimising medication packaging and implementing sustainable clinical practices, particularly in ICUs. Critical care pharmacists can help reduce pharmaceutical consumption and costs while maintaining high-quality care. However, data on medication waste in ICUs are limited, with most studies focusing on antimicrobial waste.
A recent study assessed discarded intravenous medication (DIVM) in ICUs and identified strategies to minimise avoidable waste, reduce costs, and lessen the environmental impact of healthcare.
The GAME-OVER study was a French multicentre observational study conducted between November 2022 and March 2023. The primary objective was to determine the percentage of discarded intravenous (IV) medication, measured as the ratio of discarded volume to total prepared volume. Secondary objectives included identifying risk factors and causes of medication waste and estimating its financial impact on healthcare costs.
81 ICUs and 1,076 patients participated, with 408.9 litres of 130 IV medications prepared. Of this, 43.8 litres were discarded, resulting in a 10.7% medication waste rate. Factors independently associated with increased IV medication waste included ICU admission/discharge rates, elective surgery admissions, high organ failure severity (SOFA score ≥7), endotracheal intubation, renal replacement therapy, and body mass index. 90% of pharmaceutical waste came from 25 key drugs, with an estimated national annual cost of €2,737,163.
Despite expectations, ICU medication waste was lower than that reported in operating theatres, likely due to differences in practice and the exclusion of electrolytes and vials in the study. The most frequently discarded medications included norepinephrine, propofol, insulin, heparin, sufentanil, and midazolam. Strategies to reduce waste include decreasing medication preparation volumes, using smaller containers, and utilising prefilled syringes, which can lower costs and medication errors. The presence of clinical pharmacists in ICUs could further minimise waste.
Prescription modifications were the leading cause of medication waste, highlighting the need for better communication between prescribers and nurses. The study emphasised the importance of sustainable practices, such as optimising prescriptions and reducing unnecessary syringe changes.
This large-scale study highlights the significant extent of DIVM in ICUs and its contributing factors. Reducing DIVM requires raising awareness among healthcare providers and integrating sustainable practices into daily patient care. Further research is needed to explore drug residue disposal, resuscitation fluid waste, and optimisation of drug preparation methods. These findings support the development of evidence-based, eco-friendly ICU practices, leading to benefits for patients, the environment, and healthcare costs.
Source: Critical Care
Image Credit: iStock
