Updated: Jun 29, 2021
Applying Reduce: In the next in our series of concrete actions pharmacies can take to reduce their carbon footprint using Reduce, Reuse and Recycle, we look at pill boxes.
by Ethar Alali
We recently worked with one of our customers, Alphabet Pharmacy in Stretford, Greater Manchester advising them on ways to reduce their Carbon footprint. We shadowed their team as much as we could during these times to carry out lifecycle analyses on some of their most frequent processes, then applied our novel Health-Climate-Economic models to identify the reduction in climate impact for both costs and patient health via the reduction in manufacturing and freight emissions.
The importance of Space
When it coms to climate change the smallest actions, done most frequently, can have a huge impact. Alphabet Pharmacy has been delivering both dosset and pill boxes to care homes and establishments for several years. That happened to allow them to gather a significant amount of usage data to categorise their dosage regime by 1, 2, 3 or 4 doses per day.
Both pill trays and dossets are normally split into 4 doses, 7 days a week. 28 compartments in total. However, not everyone needs 4 doses a day. When we analysed the data, 50% of tray patients have either 1 or 2 doses a day. Meaning either 2 or 3 rows in quad pill trays/dossets simply aren't used.
Together, the choice was made to replace them with Duo pill trays. Cheaper? Yes, but only by a penny per tray. In total, this reduced the costs by £2 per 200 trays, which say, in a monthly batch of 50:50 (Quad:Duo) is a reduction of 0.5% in cost. It's real benefit is a much bigger reduction in Carbon footprint.
The new Duo box cases takes up half the volume of the Quads for the same number of items. This reduces the storage footprint, which those familiar with Six Sigma will be happy with. However, it also reduces the weight of items by almost half! Allowing more to get on freight and logistics carriers and reducing the impact of CO2 from delivery.
The smaller Duo boxes also reduce manufacturing footprint by half and over a month, this is not a small number. Most trays weight 20 grams, but the amount of crude oil used to produce the trays is 4-times higher. Logistics add up to 190 gCO2/kg/km and the same again for disposal.
However, much of the logistics emissions is pushing the weight of the unladen lorry or cargo ship around. This accounts for 109 of the 190 gCO2/kg/km. Meaning in a full trailer of equipment hauled to the distribution centre or warehouse, 81 gCO2/kg/km is due to the stock.
Reducing the size by half, reduces the material by half and allows the lorry to take on twice as much load. Shrinking the volumetric size in half, reduces the carbon footprint of the delivery of containers of trays, by one truck in every two. The first run saves doing a second, the third saves dong a fourth, because the same demand is met with half the haulage and freight. In short, it saves 50% of haulage emissions and almost 50% of both manufacturing and disposal costs.
This will accumulate to reduce some of the NHS £345 million in respiratory treatment costs over time. Providing an assessment of the effect of this 50% reduction over its lifetime.
Self-Critique: Transitional, Not Permanent
While absolutely a step in the right direction, petro-plastic medicine aids are not actually the most sustainable long-term solution. That's why we've been working with Alphabet to investigate reusable recycled bioplastic aids; use existing PET as consumables for Automedi or investigate the use of cardboard compliance aids instead. Allowing pharmacies to significantly reduce their carbon footprint even further.
Why not Reusables?
Both cost and climate footprints were compared and the initial cost outlay for reusable solutions is quite significant compared to this method (£5.25 v 14p per unit) and the reusable plastic, polypropylene alternatives weighs 161g and cannot be packed smaller. While batches of PET can be stacked, like egg cartons, one inside the other.
This means it adds 10x the weight and transit emissions of PET dossets per unit; extracts 646g of oil instead of 61g but also takes up 10x the space in transit, forcing 10x the transit capacity to be used. The net effect is a lorry full of quad PET dossets can only be matched by 10 lorries of reusable compliance aids! In total, expending nearly 950-times the footprint of disposables across all of manufacture, transit, cleaning and disposal.
As dossets are used on a weekly basis, meaning these compliance aids must be reused for almost 19 years before breaking even with one PET dosset on climate impact. Furthermore, recycling PET requires lower energy and ensures embedded Carbon is not lost and its reclamation from oil, repeated.
Additionally, when a patient leaves the service for whatever reason, the aid either goes with them, or remains as an inventory item. Requiring extra storage. Something in precious little supply within pharmacy spaces in general. Especially as they occupy greater volumes.
In summary, dense plastic aids take up more volume during deliveries, are made from denser materials, require cleaning in case of residue, replacement if they happen to break, take up more space in freight and crucially, require several reuses to break-even on the capital expenditure. In practise, this is more suited to hospital pharmacies than smaller community services, unless the latter is part of a chain.
To improve the Carbon footprint of pharmacy practise, there are a number of points to consider. Many of them seem obvious to those with 5S or Six Sigma experience. Simply remember MILDS toolkit:
Disposals (including Reduce, Reuse and Recycle footprints)
Storage - Reduce the amount of space
Using these 5 rules, pharmacies can assess the footprint of purchases and align their costs and health benefits to climate outcomes.
Need help reducing the climate impact of your care organisation? Get in touch for a no obligation chat! Contact us: https://www.automedi.co.uk/contact