Delivering a carbon net zero NHS at UCLH through more sustainable inhaler prescribing in the trust

Abstract

Background Climate change, driven by anthropogenic greenhouse gas emissions, significantly impacts global health. The National Health Service (NHS) is committed to achieve net-zero carbon emissions by 2040, targeting reductions in healthcare-related emissions, including those from respiratory inhalers. Short acting beta agonist (SABA) are major contributors to the NHS’s carbon footprint due to their propellant gases. The North Central London has set key performance indicators to increase the use of lower-carbon inhalers. This project aims to primarily optimize asthma care within University College London Hospital (UCLH) by implementing sustainable inhaler prescribing practices in the emergency department (ED) and acute medical unit (AMU), aligning with these environmental goals. Methods Inhaler-sustainability champions delivered a regular education programme with interval performance of prescribing reported, following BTS-asthma 4 and surveys evaluating staff confidence pre- and post-training. Carbon footprint in NCL was calculated at community practice level and department level within UCLH to identify where more attention required. Teaching supported good disease management through prescribing of inhaled steroids and reduction in Salbutamol over-reliance with effective inhaler technique and adherence checks. We collected data pre and post interventions such as teaching to assess the impact of the educational interventions on clinical practice. Results There was an 18% and 40% reduction in SABA prescriptions in the ED and AMU respectively, cutting down carbon emissions by over 1,640 kg. Maintenance and reliever therapy prescriptions increased by 8.6% and 48% in ED and AMU, respectively. The Asthma 4 bundle application improved in the AMU. A staff surveys revealed overall improvement in knowledge and understanding after the educational intervention. Conclusion The implementation of sustainable inhaler prescribing practices in the ED and AMU at UCLH has led to a reduction in carbon emissions and improvements in clinical practice. Additionally, the educational interventions resulted in enhanced staff knowledge and understanding around optimal asthma care. These outcomes highlight the potential for such quality improvement initiatives in achieving both clinical excellence and environmental sustainability within healthcare settings