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EMBEDDING INHALER RECYCLING INTO THE NHS

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European Statement

Education and Research

Author(s)

Laura Morgan

Why was it done?

Inhalers are the largest single contributor among medicines to the NHS carbon footprint, accounting for 3% of total NHS emissions. In 2020, the NHS became the first health system globally to commit to Net Zero, later formalised through the Health and Care Act 2022 and the Delivering a Net Zero National Health Service report, which provides statutory guidance to ICBs. This project responds to that call-to-action and aligns with South East London’s Green Plan, which pledges to reduce emissions within its footprint. It also serves as a proof-of-concept to inform NHS England’s assessment of the viability of nationwide, routine inhaler recycling.

What was done?

Developed as an innovative sustainable project in response to NHS Net Zero ambitions and SEL Integrated Care System’s (SEL ICS) Green Plan, SEL ICS launched the first fully NHS-funded, ICS-wide inhaler recycling pilot in England. The scheme is fully integrated across primary and secondary care and enables the public to recycle used inhalers at any participating site. The inhalers are then transported to a recycling facility (Grundon Waste Management) for up to 99.9% recovery of propellants, plastics, and aluminium. This pilot serves as a proof-of-concept to assess the feasibility of business-as-usual inhaler recycling in the NHS.

How was it done?

An inhaler recycling pilot is being delivered across 20 community pharmacies and five acute/mental health trusts in SEL. A project working group (PWG) and formal memorandum of understanding was established between South East London Integrated Care Board, NHSE, King’s College Hospital (KCH), SEL Pharmacy Alliance, Guy’s and St Thomas’ (Essentia), and other stakeholders to ensure structured, cross-sector collaboration. The project leveraged existing NHS clinical waste infrastructure to recycle pressurised metered dose inhalers (pMDIs), ensuring operational efficiency with minimal disruption. The PWG collaborated with behavioural science colleagues and patient engagement groups to develop public-facing communications that encouraged appropriate inhaler disposal. All activities were embedded into routine workflows without additional staffing. Monthly data submissions from participating sites enabled continuous monitoring and will inform a fully commissioned evaluation.

What has been achieved?

Over 16,000 inhalers have been collected so far, with more than 11,000 returned through community pharmacies. The current recoupment rate at community pharmacies is approximately 15%, i.e., the number of pMDIs reported returned is around 15% of the high-carbon pMDIs dispensed by that pharmacy in the same month. This figure will undergo further scrutiny in the final evaluation, after corroboration by Grundon data following the project’s last recycling cycle. The project has also seen strong patient and public involvement. A live public-facing survey on the SEL website has received more than 100 responses to date. Themes identified include low awareness of proper disposal routes, strong interest in inhaler recycling, and improved understanding and willingness to return inhalers after campaign exposure. These results demonstrate meaningful public input and are informing ongoing communication strategies. In terms of reach and influence, the pilot has attracted national and international interest with over 25 NHS providers across the country having contacted the SEL team for support with replication, and a Canadian research group has requested to learn best practice from the model. The project demonstrated high operational feasibility, environmental impact potential, and strong appetite for scale-up. Complete evaluation is ongoing.

What next?

This innovative project shows inhaler recycling can be embedded in existing NHS systems. It presents a replicable and scalable national model, supporting medicines optimisation, waste reduction, and sustainability; it stands apart by being completely publicly owned, leveraging existing NHS contracts and infrastructure, without the need to rely on external sponsorships. This pilot offers a practical blueprint for embedding environmental sustainability into medicines optimisation across the NHS and the outcomes will inform future commissioning and advance the NHS’s Net Zero goals.
An evaluation of the pilot is currently being developed with the last inhaler collection at all sites due January 2026; the evaluation is due to be published in the Spring of 2026.

PHARMACY TECHNICIANS SATISFACTION SURVEY ABOUT PROCEDURE IMPROVEMENT PROCESS IN SAFE DISPENSING MEDICATION

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European Statement

Patient Safety and Quality Assurance

Author(s)

L. DE AGUSTIN SIERRA, P. FLOX BENITEZ, B. MONTERO PASTOR, A. SUCH DIAZ, P. TEJEDOR PRADO, E.A. ALVARO ALONSO, E. IZQUIERDO GARCIA, N. FONT TARRES, M. SANCHEZ LORENZO, I. ESCOBAR RODRIGUEZ.

Why was it done?

Medication dispensing errors were detected more frequently in our Pharmacy Department. This errors were related with procedures among pharmacy technicians (PT).
Formation programs bettween PT are implemented in our Pharmacy Department in other critical areas such as compounding or cytotoxic drugs but not dispensing.
It its known that a lack of knowledge of established work procedures among pharmacy technicians (PT) can contribute to a potential increase in medication dispensing errors. On the other hand, medication dispensing errors are preventable incidents in the process of distributing and administering drugs that can cause avoidable harm to patients.

What was done?

Implementation of a procedure manual to define operative procedures carried out by PT that need improvement in the safe dispensing medications and establish appropriate measures for safer and efficient work.

How was it done?

Observational, prospective, descriptive study conducted by pre and post survey (1-5) during July and september 2025 among PT.  The total number of surveys was 28 (15 pre and 13 post).
A structured questionnaire was developed with closed question (pre and post) about: (1) medication distribution and dispensing, (2) knowledge of stablished operative procedures, (3) clinical pharmacy services and medicine information, (4) personal abillities and skilss and (5) necesity for training and information.
Surveys included 11 questions using Google Forms Likert scale of 1-5, being 5 maximum score.
Post-survey was conducted after three-months period training for PT.

What has been achieved?

In pre-survey, medication distribution and dispensing received the lowest score (3 on five-point scale). The rest of responses showed a satisfaction degree (4) also for necesity for training and information.
After manual implementation, post-survey questionnaire shows that manual enhanced work procedures and medication distribution, dispensing (3 pre Vs 4 post), self-confidence and autonomy in established procedures. (4 on five-point scale). Moreover, overall satisfaction about was satisfied (4).

What next?

The implementation of a procedure manual has enhanced generally satisfied between PT. Although our survey shown this enhances, we are conscious about importance and necessity of reglated formation in Pharmacy Department in order to safe dispensing medications and safer and efficient work. For that reason, reglated formation has been scheduled among PT.

User satisfaction assessment in outpatient pharmaceutical consultations: results and future perspectives

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European Statement

Patient Safety and Quality Assurance

Author(s)

Eva Gomez-Costa, Purificacion Cid-Silva, Juan Luis Hurtado-Bouza, Laura Caeiro-Martinez , Pablo Feijoo-Vilanova, Andrea Luaces-Rodriguez, Sandra Rotea-Salvo, Alejandro Martinez-Pradeda , Maria Isabel Martin-Herranz

Why was it done?

The purpose is to identify deficiencies and improvement areas in the outpatient consultation area for evaluation and proposal of possible solutions.

What was done?

Implementation of an user satisfaction evaluation system for outpatient consultations at the Pharmacy Service of a tertiary-level hospital and initial results assessment.

How was it done?

The system was put into operation in January 2023 through a QR code placed in each consultation room and in the waiting areas accessible to all patients. The survey allows for differentiation between the different pharmacy service centers in the hospital, patient-caregiver patient category, age group, and whether it was the first consultation or an appointment for treatment continuation. Users can rate aspects related to information, waiting time from the appointment time to receiving attention, the professionalism of the staff, respect for privacy, pharmaceutical information about the treatment, and the facilities. This rating can be classified into: very good, good, bad, very bad, except for the waiting time: reasonable or excessive. Final question is an overall assessment of the service from 0 to 10. Survey allows for comments or suggestions.

What has been achieved?

A total of 86 surveys were conducted between January and September 2023. The majority were from users of the pharmacy service in the main building of the university hospital complex (82.6%). 10.6% were from first-time appointment and were mainly patients who answered (67.4%). Age groups: 65 years (12.8%). Regarding the evaluation, the results were: information about appointments, 51.8% very good; waiting time from the appointment time to receiving attention, 59.3% reasonable; professionalism of the staff, 59.3% very good; respect for privacy, 59.3% very good; pharmaceutical information about the treatment, 51.2% very good. The evaluation of facilities where pharmaceutical care is provided to the patient were: 33.7% bad and 9.3% very bad. The average score for the overall assessment was 6.7 points.

What next?

The evaluation of the information obtained from the surveys will serve as a basis for implementing corrective measures and possible improvements. The progressive increase in the number of survey will facilitate the detection of new issues and allow us to track changes in user satisfaction over time.

The current landscape of medical device education for hospital pharmacists: where do we stand?

European Statement

Education and Research

Author(s)

Lorenzo Di Spazio, Daniele Mengato, Andrea Ossato, Vera Damuzzo, Marco Chiumente, Giulia Dusi, Sabrina Trippoli, Andrea Messori, Maria Cecilia Giron, Maria Chiara Silvani, Francesca Venturini

Why was it done?

MD training, both undergraduate and postgraduate, appears to be scarce and, when available, seems to chase rather than anticipate real innovation. As a result, hospital pharmacists often have inconsistent levels of training that need to be investigated and harmonised.

What was done?

Medical devices (MD) are serving an increasingly central role in clinical practice, improving patients’ health and quality of life. In recent years, the MD industry has grown considerably along with its innovation, sophistication and spending. This context requires not only technical, but also management and consulting skills, in particular for pharmacists, that should be adequately trained and continuously updated in order to increase their involvement in the patient care pathway. A special survey has been designed and sent out to hospital pharmacists in order to gauge their level of knowledge on this subject.

How was it done?

A survey, available from 1 October 2022 to 31 December 2022, was created by a pool of experts from an Italian scientific society (Italian Society of Clinical Pharmacy and Therapeutics – SIFaCT) and shared through Google Forms to evaluate the state-of-the-art of MD’s clinical pharmacy practice, characterising the participants on their training background and needs in this field. The questions aimed to describe which courses (curricular or post-university) on MD had been followed by the participants to individuate the best possible interesting topics and the preferred training tools useful for the SIFaCT’s future educational activities.

What has been achieved?

Out of 142 responses, only 36 (25%) declared to have followed specific training courses on MDs while 102 (72%) stated that they were self-taught in this matter. 138 participants (97%) stated the need to broaden their knowledge through: training meeting (34%), sharing of procedures and/or operating instructions (33%), access to short editorial contributions (23%) and scientific studies (10%). The three most requested topics for future trainings were: innovative MDs and innovation governance (HTA), updates on legislation and technical insights on specific classes of MDs.

What next?

These results represent a background for developing a training project aimed to increase pharmacists’ knowledge on MDs.
MD topic, according to Regulation (EU) 2023/607 and 2017/745, is constantly updated and the pharmacist must be able to understand and implement the requirements of the national and European legislation to protect safety, safeguard public health and recognize technological innovation. Finally, these results highlight the need of specific university courses for pharmacists to develop technical and clinical skills on MDs.