Green NephrologyGreen NephrologyRenal Dialysis UnitRenal Dialysis Unit

Vale of LevenVale of Leven

Leigh BainbridgeLeigh Bainbridge

leighbainbridge@nhs.netleighbainbridge@nhs.net

BackgroundBackground• NHS is the biggest polluter of CO2- About 25% of all public NHS is the biggest polluter of CO2- About 25% of all public

sector emissionssector emissions

• Carbon Management Plan – Legal requirement. Carbon Management Plan – Legal requirement.

• NHSGGC Carbon Management Plan commits us reduce NHSGGC Carbon Management Plan commits us reduce emissions by a minimum of 25% by 2016emissions by a minimum of 25% by 2016

• Renal is a particularly resource intensive specialityRenal is a particularly resource intensive speciality

• Campaign for Greener Healthcare was started in 2008 in Campaign for Greener Healthcare was started in 2008 in response to improving healthcare in the futureresponse to improving healthcare in the future

• Consists of a small team, with a large network of partners Consists of a small team, with a large network of partners working across different specialities. working across different specialities.

www.sustainablehealthcare.org.ukwww.sustainablehealthcare.org.uk

10:10 Renal Checklist10:10 Renal Checklist

• The Centre for Sustainable Health – Green The Centre for Sustainable Health – Green nephrology Network, Green stars and developing nephrology Network, Green stars and developing practicepractice

• Framework produced by The Centre for Sustainable Framework produced by The Centre for Sustainable Health to cut carbon emissions by 10% in 2010.Health to cut carbon emissions by 10% in 2010.

• BUT…it is applicable at any time in any year!BUT…it is applicable at any time in any year!

• It is also applicable to ANY speciality, ward, clinic, It is also applicable to ANY speciality, ward, clinic, unit etc.unit etc.

Waste Management ProjectWaste Management Project

How we made the change…How we made the change…

• High level engagementHigh level engagement• Identify ground level link nursesIdentify ground level link nurses• Asked for helpAsked for help• Initial meetingInitial meeting

– Existing practiceExisting practice– Areas of opportunityAreas of opportunity– Identify first stepsIdentify first steps– Possible barriersPossible barriers

• Audit and do!Audit and do!

Getting StartedGetting StartedTeam

•6 outpatient haemodialysis units – each with link nurse•Full cooperation of management and RDU SCNs•Renal nurse educator•Consultant nephrologist •Sustainability manager

Quick wins-Green Nephrology Programme Fife•Audit current patterns of consumable disposal equipment •Identify safe opportunities for reducing clinical waste•Identify equipment that could be safely removed from the process

Disposables of a Haemodialysis TreatmentDisposables of a Haemodialysis Treatment

Savings-cost and carbon emissions from waste Savings-cost and carbon emissions from waste streamingstreaming

• WASTE STREAMING SAVINGS WASTE STREAMING SAVINGS

COST SAVINGSCOST SAVINGS £14,318 / £14,318 / yryr

CO2eCO2e 80 80 tonnes/yrtonnes/yr

Savings-cost and carbon Savings-cost and carbon emissions from safe emissions from safe elimination of equipmentelimination of equipment

• GRIFF BINS – 14,000 / yrGRIFF BINS – 14,000 / yr

• £92,592 saved /yr£92,592 saved /yr– £84,000 buy£84,000 buy– £8,592 dispose£8,592 dispose

• Approx 43 tonnes CO2e Approx 43 tonnes CO2e

• Discontinued use early 2012Discontinued use early 2012

Total Annual SavingsTotal Annual Savings(6 units, 500 patients)(6 units, 500 patients)

£106,910.00£106,910.00

123 tonnes CO2e123 tonnes CO2e

Sustainable Action PlanningSustainable Action Planning

• CO2 Resource Efficiency ToolCO2 Resource Efficiency Tool• Tool employed to carry out effective action Tool employed to carry out effective action

planning.planning.• Energy/ Environmental/ Waste walkaboutEnergy/ Environmental/ Waste walkabout• Available from the Centre for Sustainable Available from the Centre for Sustainable

Healthcare website under the Green Healthcare website under the Green Nephrology sectionNephrology section

• Submission and evaluation of action planningSubmission and evaluation of action planning

SO, what are we doing?SO, what are we doing?

Reduce, Re-use, Re-cycleReduce, Re-use, Re-cycle• Reduce: Reduce: Waste Reduction Project (quick wins)Waste Reduction Project (quick wins)

patients bring own blanketspatients bring own blankets

• Re-use:Re-use: Creative uses for objectsCreative uses for objectse.g. Gallipotse.g. GallipotsExamining practiceExamining practice

• Re-cycle: Re-cycle: Printer cartridgesPrinter cartridgeswww.reclaim-it.comwww.reclaim-it.comBatteriesBatteriesBall point pens and inhalersBall point pens and inhalerswww.terracycle.co.ukwww.terracycle.co.ukCardboard boxesCardboard boxesWooden PalletsWooden PalletsBottle tops to ‘Lush’ – free face packsBottle tops to ‘Lush’ – free face packs

More can be done…Equipment freecycling, food wastage, sharps box re-usage. More can be done…Equipment freecycling, food wastage, sharps box re-usage.

LightingLighting

• Stickers and Posters from the Carbon TrustStickers and Posters from the Carbon Trust www.carbontrust.co.ukwww.carbontrust.co.uk

• Ensured that all our light bulbs are replaced Ensured that all our light bulbs are replaced with energy efficient oneswith energy efficient ones

• Liaised with estates to ensure old light bulbs Liaised with estates to ensure old light bulbs are recycled.are recycled.

• Motion sensors in place in appropriate areasMotion sensors in place in appropriate areas

Heating and CoolingHeating and Cooling

• Fresenius 5008 dialysis machines are Fresenius 5008 dialysis machines are fitted with heat exchangers but these fitted with heat exchangers but these can be retrofitted to machines that can be retrofitted to machines that don’t have them. Grants are available.don’t have them. Grants are available.

• Posters from The Carbon Trust.Posters from The Carbon Trust.• Radiators TVRs set to 3.Radiators TVRs set to 3.• Regulate Air conditioning.Regulate Air conditioning.• Education.Education.

Save WaterSave Water

• Reporting LeaksReporting Leaks

• HipposHippos

• Re-use of grey Re-use of grey waterwater

Papers and printersPapers and printers

• Recycled paper used at all times.Recycled paper used at all times.

• Scrap paper used for note taking.Scrap paper used for note taking.

• Printers set to economy and double Printers set to economy and double sided printing.sided printing.

• ‘‘A’ Energy equipment bought as A’ Energy equipment bought as replacement.replacement.

Telephone ClinicsTelephone Clinics

• Appropriate patients are identified and Appropriate patients are identified and have telephone appointments during at a have telephone appointments during at a dedicated timededicated time

• Bloods taken by GP Bloods taken by GP

• 11stst year results year results– 5709 miles saved5709 miles saved– 2.26 tonnes CO2e2.26 tonnes CO2e– £663 saved in reimbursement (more if required £663 saved in reimbursement (more if required

hospital transport)hospital transport)

Staff TravelStaff Travel

• An area that is being tackled in the hospital An area that is being tackled in the hospital through The Healthier Working Lives Group.through The Healthier Working Lives Group.

• Changing rooms with showers for cyclists Changing rooms with showers for cyclists are availableare available

• Locked bicycle sheds are available.Locked bicycle sheds are available.

• NHS GGC initiatives are publicised and staff NHS GGC initiatives are publicised and staff are made aware.are made aware.

• Car sharing is encouraged.Car sharing is encouraged.

Patient TravelPatient Travel

An area that is largely out of my locus of control, An area that is largely out of my locus of control, HOWEVER…HOWEVER…

• I can encourage ambulance drivers NOT to leave I can encourage ambulance drivers NOT to leave their engines idling whilst waiting on patients.their engines idling whilst waiting on patients.

• I can also pass on any information I receive about I can also pass on any information I receive about greener fleets etc. to the right persongreener fleets etc. to the right person

• I can discuss green initiatives with the ambulance I can discuss green initiatives with the ambulance crew.crew.

……a little may just lead to a lot.a little may just lead to a lot.

Low Carbon ShoppingLow Carbon Shopping

• An area that can be tackled by the An area that can be tackled by the Renal procurement group.Renal procurement group.

• Shop floor ideas can be escalated to Shop floor ideas can be escalated to them.them.

Decarbonise Patient CareDecarbonise Patient Care

• An area for the future… Preventative An area for the future… Preventative care is always the best kind of care.care is always the best kind of care.

• Current focus on diabetic feet and Current focus on diabetic feet and diabetic controldiabetic control

Barriers to changeBarriers to change• Health and safetyHealth and safety

– Griff bins + new bagsGriff bins + new bags– Reusable sharps boxesReusable sharps boxes

• Procurement Procurement – dressing packsdressing packs– National contractNational contract– Set up renal group to input into tenderSet up renal group to input into tender

• Infection controlInfection control– Need to involve early and keep onsideNeed to involve early and keep onside– Saline bag removalSaline bag removal– New bags need to be off floor – new sack holderNew bags need to be off floor – new sack holder

The FutureThe Future

• Ongoing audit to drive improvementOngoing audit to drive improvement

• Key Performance IndicatorsKey Performance Indicators

• Consistency of practiceConsistency of practice

• Sharing of ideas and informationSharing of ideas and information

• Extending to other high resource Extending to other high resource areas areas