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As a Respiratory team at Sheffield place SY ICB we recognised that alongside addressing SABA over-reliance we could also tackle our carbon emissions generated from inhalers by a simple switch of brands. We identified that different brands of Salbutamol inhalers have a smaller canister so therefore contain less propellant than others and therefore are less damaging to the environment. The brand Salamol was identified as it has a considerably lower carbon footprint than Ventolin Evohaler (12kg co2e vs 28kg co2e). We developed a process to reduce our carbon emissions per Salbutamol inhaler by changing our formulary choice to Salamol.
We identified a primary care network with quite high prescribing of generic Salbutamol and brand Ventolin and approached the clinical director with a proposal to switch all patients onto the brand Salamol. After identifying over 2000 patients and realised the time and cost this would take implementing by individually switching each patient, we held a discussion within the sustainable respiratory group which consists of primary and secondary care clinicians and non-clinicians, patient representatives and the NHS net zero clinical lead who all collectively decided the most efficient and effective way to implement this was by bulk switching patients onto Salamol. As a team we do not routinely advocate bulk switching and would certainly not use this method to change any inhalers of different devices but as the change was a like for like switch and the new brand would suit most patients so it was decided this would be appropriate. After seeing the low level of pushback from patients this has reiterated that this method was appropriate for this change.
Once approved we trialled the bulk switch in 4 of the practices in the primary care network with a view to assess the results and impact of the change in 12 weeks. After 12 weeks the results showed that the process had been extremely successful with 98% of patients remaining on Salamol, the results showed there was very little push back from patients. This did not only have a cost saving of monetary value, but the most important outcome was the reduction on carbon emissions which I have outlined the details of in the measurable evidence and impact section.
There was an additional benefit by performing this work by bulk switching as if each patient was switched individually, it would have taken a considerable amount of time. We calculated that it would have taken around 196 hours if we spent around 5 minutes per patient which in comparison to the 2 hours it took to do the bulk switching process the difference is significant. This resulted in a cost saving for staff time, based on an average Pharmacy Technicians hourly rate the saving was just over £2683.
