Medicines
Emissions from the production, use and disposal of medicines is a large emissions hotspot within acute trusts. Initial work focussed on the removal of desflurane, the most damaging of inhaled anaesthetic agents, which was removed from NHS formularies in 2024.
Both the inhalers and anaesthetic gases, including Entonox, are included in the NHS 2040 net zero target. Other prescribed medicines are included in the 2045 net zero target.
Where we are now:
KGH has a dedicated team of pharmacists and an aseptic unit within the Trust.
Information relating to the environmental impact of inhalers has been difficult to obtain until recently, therefore 2024/25 will be the baseline year for any reduction targets. CO2e emissions from anaesthetic gases, nitrous oxide and Entonox, as obtained from the Greener NHS dashboard are shown in Figure 3 below.
Figure 3 Emissions from anaesthetic gases and Entonox
KGH removed Desflurane from December 2023 which reduced its emissions from volatile agents to 67.2 tonnes CO2e in 2024/25, a reduction of over 400 tonnes CO2e in six years.
Another high emitter of greenhouse gases is nitrous oxide used as an anaesthetic in theatres and for pain relief in the form of Entonox in maternity and areas such as the Emergency Department. Work has shown that there is significant leakage from nitrous oxide manifolds serving theatres no matter the diligence of the Estates testing regime. A large reduction is shown in the Entonox emissions with the repair of a leak, followed by the change of the manifold in 2023/24. The Royal College of Anaesthetists endorsed the removal of nitrous oxide manifolds within theatres. Removal of this at KGH, following the process adopted at NGH will be a priority for the delivery of this sustainability plan.
An area of high priority is the switch from IV (intravenous) to oral medication, particularly for paracetamol and some antibiotics. Not only does this reduce waste, costs and carbon emissions, it can also save significant amounts of staff time and reduces the potential for patient infections. Work has been started to prescribe oral paracetamol for pre-operative patients, and the Trust has significantly reduced its prescription of IV antibiotics. This latter project has shown emission reductions of over 200 tonnes CO2e are possible across NGH and KGH.
Our aims are to:
• Reduce carbon emissions from nitrous oxide and Entonox by 25% compared to 2024/25
• Reduce carbon emissions per inhaler prescribed by 25% compared to 2024/25
• Reduce the amount of IV medicines prescribed by 10%
• Calculate the carbon emissions from medicine prescriptions
• Reduce medicines wastage and calculate the sustainability impact
Action |
Financial Investment |
When |
Responsible Department |
| Remove nitrous oxide manifolds from theatres | Low | 2026 | Pharmacy / Estates |
| Replicate the project relating to Patients' Own Drugs from other Trusts | Low | 2027 | Pharmacy |
| Calculate carbon emissions from IV vs oral medicines | Low | 2026 | Pharmacy |
| Extend and capture savings from IV to oral antibiotics | Low | 2027 | Pharmacy |
| Extend and calculate savings from IV to oral paracetamol | Low | 2027 | Pharmacy |
| Introduce insulin pen recycling | Low | 2025 | Pharmacy |
| Establish a green group within Pharmacy | Low | 2025 | Pharmacy |
| Use pharmacy knowledge to educate staff and patients regarding lower environmental impact options | Low | 2026 | Pharmacy |
| Review options for calculating carbon emissions from medicines beyond anaesthetics and inhalers | Low | 2027 | Pharmacy |
| Include reporting of medicines wastage reduction projects into SD Committee | Low | 2025 | Pharmacy |
Measurement
Annual reporting of anaesthetic gases and Entonox from Pharmacy orders
Annual reporting of inhaler data from Pharmacy
Reduction in medicines wastage from Pharmacy
IV prescriptions from Pharmacy