Reducing the Carbon Footprint of Inhaler Prescribing in Swansea Bay University Health Board's Primary Care Sector

Swansea Bay University Health Board

The biggest NHS carbon footprint in primary care is associated with metered dose inhalers (MDIs). MDIs contain hydrofluoroalkane (HFA) propellants to create an aerosol for drug delivery which have been identified as potent greenhouse gases with high global warming potential. MDIs currently contribute 3.5% to the total NHS carbon footprint in the UK. Dry powder inhalers and soft mist inhalers do not contain HFAs and so have a much lower carbon footprint. Prescribing culture in the UK currently favours MDIs, with them accounting for 70% of all inhalers prescribed here, compared to 14% in Sweden.

The Medicines Management Team (MMT) in Swansea Bay University Health Board (SBUHB) met to explore the different interventions that could influence a reduction in the carbon footprint associated with inhaler devices. The initial aim was to reduce the carbon footprint associated with inhaler devices, with two primary drivers: to look at appropriate disposal of inhalers and to look at a change in prescribing.

ScriptSwitch is a software that displays prescribing messages and prompts drug switches to prescribers in GP practices at the point of prescribing. Basic ScriptSwitch messages were written and deployed by the MMT to trigger at the prescribing of certain MDIs, prompting the prescription of a different type of inhaler containing lower amounts of HFA propellants. Prior to authoring the decarbonisation messages, process mapping was used to establish when the switches would be presented, and to confirm they were clinically appropriate and did not add additional workload to practices. Data was collected based on the acceptance rates of the prompts.

Results indicated that the overall carbon footprint saving of the three-month project was 67,000 KgCO², which is roughly equivalent to saving the footprint of 1,112 return trips from Swansea to London in a petrol car.

Gemma Williams

gemma.williams15@wales.nhs.uk