Wastefulness in healthcare

[Emergent]

I'm pushing to start a program to reduce wastefulness where I work. Not only is it expensive but it's environmentally deleterious.

I'd love to hear ideas from you all.

[K+MgSO4, BSN]

My hospital has a number of programmes.

Baxter IV bags and oxygen tubing/ masks with the hard bits and metal removed are recycling by a guy that uses them to make garden hoses and other garden furniture.

Single use instruments are run through the washer and sent to a metal recyclers.

Suture packets are also recycled as well.

An anaesthetist in regional Victoria set up an initiative called little blue towels where the huck towels are reprocessed and soldhttp://www.littlebluetowels.com.au/

batteries from equipment are collected in each local area and are sent to recycling depot.

We are working actively on finding a cost effective paper pill cup to replace the majority of the plastic pill cups.

Paper bags rather than plastic for patient belongings

Staff tea rooms have a supply of metal cutlery rather than plastic.

Patients are given washable jugs and cups for water

Paper cups for visitors /large volume liquid meds are biodegradable.

Replaced single portion jam / vegemite in the staff room with a jar (buy your own if you don't like it)

Replaced all the mops for environmental services to microfiber so they use less water

Involved in the end PJ paralysis https://www.endpjparalysis.com/ with along with all the benefits to patients is less use of hospital gowns.

Kimgaurd (sterile tray wrap) recycling http://www.kimberly-clark.com.au/en/news/2011/newsbox/kimberly-clark-health-care-offers-hospitals-innovative-recycling-solution/

Store room audits by supply, clinicall product advisor, infection prevention and manager together at least once a year to review stock levels if items are constantly running out and extra trucks being used to make urgent deliveries, what stock has been superseded by newer products, no longer endorsed by the hospital (I did one of these on a ward that had a hand hygiene product on the shelf that was 3 product changes ago). That items are stored appropriately so sterility is maintained, stock rotation for expiration dates. If the stock levels of a product is to high and it is wasteful etc.

That's all I can think of currently.

[K+MgSO4, BSN]

O also, we let staff who are moving house take kimgaurd for packing and the empty boxes that items get bulk delivered in that would get flattened and sent to recycling.

[amoLucia]

11 hours ago, K+MgSO4 said:

O also, we let staff who are moving house take kimgaurd for packing and the empty boxes that items get bulk delivered in that would get flattened and sent to recycling.

Also worked a place where they would just leave the big cardboard packing boxes in a designated area for any staff to help themselves.

One CNA always took away big boxes and flattened them. She used them in her garden to surround her plantings by laying them on the nearby ground. The flat boxes would inhibit weeds from growing around her plant. (She loved to garden but hated the chore of weeding.) I tried it just to control weeds in an unplanted border next to my condo and it WORKS really well. (But it is kind of nasty to remove them after a season of being down.)

[zoidberg, BSN, RN]

On 5/30/2019 at 9:22 PM, Kitiger said:

I do private duty homecare, and we don't waste nearly as much as the hospitals do. Probably most of the hospital waste is due to infection control. Hospitals change out equipment that we normally wash and reuse, things like nebulizers, O2 masks, nasal cannulas, and suction canisters. We typically use one suction cath per shift for trachs. How does that compare to hospitals?

New suction kit, every time! kit has gloves (the terrible kind) and a catheter. Use and dispose. Repeat. Most things are thrown out. BP cuffs, SCD sleeves, and some types of pulse ox probes are “recycled” whatever that means.

[pebblebeach, BSN, RN]

On 5/31/2019 at 5:53 PM, amoLucia said:

Another favorite of mine is the sterile IV drsg kits that will be opened only to remove the clear biofilm/opsite date drsg because the original first one got all sticky-ed up and a new film is needed.

I completely agree with all of this, but if there are no spare films available to you except for in the kits, what else do you do? I wish more of the individual supplies in our kits (right now blood culture bags and port access trays come to mind) left some of the critical items in it (biopatch, angelwings) out separately, so that if you need another you don't have to open another kit. I always wonder who makes the decision of what is packaged together and separately, why is there suddenly a new brand of tape, etc. etc.

Medical waste is such an overwhelming problem, as a new nurse I feel swamped enough by simply staying on top of my tasks right now, but at some pt in my career I would like to focus on it.

I worked as a tech on an ortho unit years ago, and somehow this hospital could afford a pack of Pampers wipes (like- Costco size ones) for each patient in the admission bucket. The pt would usually ask for more during their stay. Well, come discharge, there's 3 unopened Pampers packs left in the room that have to be thrown out bc the pt has a history of MRSA or something -- meanwhile they could be used by parents who can't afford wipes. That one really got to me.

Maybe opened kits/leftover supplies in non-iso rooms can be donated to a nursing school?

[OncologyCat, BSN, RN]

On 5/30/2019 at 11:48 PM, Emergent said:

IV tubing, urinals, paper, hats, NCs.

I agree. We go through so many items, esepcially when a pt is discharged, whatever that is left in the room needs to be trashed, including disposable stethoscopes and curo caps! I unfortunately don’t have any suggestions, but I feel like management keeps saying it’s because of infection control.

[OncologyCat, BSN, RN]

Also, don’t even get me started on the pre-assembled kits! We have central line dressing change kits now that we’re supposed to use, but honestly I don’t like the prepackaged masks and sterile gloves they put in there. So I end up bringing other items and trash most of the things in the kit anyway. Talk about wastefulness!

[K+MgSO4, BSN]

3 hours ago, pebblebeach said:

I completely agree with all of this, but if there are no spare films available to you except for in the kits, what else do you do? I wish more of the individual supplies in our kits (right now blood culture bags and port access trays come to mind) left some of the critical items in it (biopatch, angelwings) out separately, so that if you need another you don't have to open another kit. I always wonder who makes the decision of what is packaged together and separately, why is there suddenly a new brand of tape, etc. etc.

most of those packs should be "custom kits" where the purchaser i.e. the hospital instructs what is put into it. Your hospital should have someone who part of their job it is to negotiate the design of the custom kits. If the items that are in it no longer meet the needs of the staff then they should be approached to review it.

There has to be a way that other items that are needed can be stored separately - e.g. the IV tegaderm is also kept on the shelf individually as previously stated it gets all tangled up. Speak up and find out how to change this in your organisation.

The new brand of tape etc is often down to 2 reason - cheaper supplier or the current brand is no longer on the approved list of purchasers for the organisation. Often an organisation with strong buying power will have negotiated a deal with a supplier as a high volume purchaser for a lower price. This is often for a fixed term of 3-5yrs depending on the contract. In that time other companies will work on how to get that in the next contract.

[FAB_RN, BSN]

Medicine cups. Unless it’s being used for a liquid med I try to leave the medicine cup on the patient’s bedside table so we’re not going through 3, 4, 5+ medicine cups during the day when the patient has medications due. Incredibly wasteful and unnecessary.

[WestCoastSunRN, MSN, CNS]

The wastefulness drives me batty. We have tried to make some changes but infection control turned us back around -- BUT... I know there is much more we can do. There have been some great ideas on this thread! I wanted to get involved with this at work, but other needs there took priority for now. That said, I am stoked about the idea of donating unused supplies and am going to look into this. Thanks for starting this thread, @Emergent!

[hawaiicarl, BSN, RN]

I think the topic is overwhelming Emergent, like where do we start? Do we start with the concept of Western Medicine not being preventative? Do we delve into the futility of care of coding, and keeping a 98 year old lady with a POLST on life care for a month because her lazy *** kids still collect her social security checks, and live in her house? Or do we delve into the seedy underworkings of big pharm and hospital lobbyists trying to corrupt our purely innocent politicians? I am so overwhelmed by this topic that I am superfluously flabbergasted.

Cheers

[LilPeanut, MSN, RN, NP]

End of life care is a lot of the costs. I also really advocate for decreasing the number of lab draws and other procedures that can really add up but don't always contribute meaningfully to the care.

The number of times people get a blood gas, when they aren't going to do anything about it drives me nuts. There are a lot of labs like that where I am. (and worse, they don't get labs when they do need it, because it's not the "regular" time to draw them)

Supplies are really a small drop in the bucket - reducing length of stay, reducing futile care, reducing unnecessary labs and tests, those make a huge impact.