Green Nephrology Renal Dialysis Unit Vale of Leven

1. Green NephrologyRenal Dialysis UnitVale of Leven Leigh Bainbridge leighbainbridge@nhs.net

2. Background • NHS is the biggest polluter of CO2- About 25% of all public sector emissions • Carbon Management Plan – Legal requirement. • NHSGGC Carbon Management Plan commits us reduce emissions by a minimum of 25% by 2016 • Renal is a particularly resource intensive speciality • Campaign for Greener Healthcare was started in 2008 in response to improving healthcare in the future • Consists of a small team, with a large network of partners working across different specialities. www.sustainablehealthcare.org.uk

3. 10:10 Renal Checklist • The Centre for Sustainable Health – Green nephrology Network, Green stars and developing practice • Framework produced by The Centre for Sustainable Health to cut carbon emissions by 10% in 2010. • BUT…it is applicable at any time in any year! • It is also applicable to ANY speciality, ward, clinic, unit etc.

4. Waste Management Project

5. How we made the change… • High level engagement • Identify ground level link nurses • Asked for help • Initial meeting • Existing practice • Areas of opportunity • Identify first steps • Possible barriers • Audit and do!

6. Getting Started • Team • 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

7. Disposables of a Haemodialysis Treatment

8. Savings-cost and carbon emissions from waste streaming • WASTE STREAMING SAVINGS COST SAVINGS £14,318 / yr CO2e 80 tonnes/yr

9. Savings-cost and carbon emissions from safe elimination of equipment • GRIFF BINS – 14,000 / yr • £92,592 saved /yr • £84,000 buy • £8,592 dispose • Approx 43 tonnes CO2e • Discontinued use early 2012

10. Total Annual Savings(6 units, 500 patients) £106,910.00 123 tonnes CO2e

11. Sustainable Action Planning • CO2 Resource Efficiency Tool • Tool employed to carry out effective action planning. • Energy/ Environmental/ Waste walkabout • Available from the Centre for Sustainable Healthcare website under the Green Nephrology section • Submission and evaluation of action planning SO, what are we doing?

12. Reduce, Re-use, Re-cycle • Reduce: Waste Reduction Project (quick wins) patients bring own blankets • Re-use: Creative uses for objects e.g. Gallipots Examining practice • Re-cycle: Printer cartridges www.reclaim-it.com Batteries Ball point pens and inhalers www.terracycle.co.uk Cardboard boxes Wooden Pallets Bottle tops to ‘Lush’ – free face packs More can be done…Equipment freecycling, food wastage, sharps box re-usage.

13. Lighting • Stickers and Posters from the Carbon Trust www.carbontrust.co.uk • Ensured that all our light bulbs are replaced with energy efficient ones • Liaised with estates to ensure old light bulbs are recycled. • Motion sensors in place in appropriate areas

14. Heating and Cooling • Fresenius 5008 dialysis machines are fitted with heat exchangers but these can be retrofitted to machines that don’t have them. Grants are available. • Posters from The Carbon Trust. • Radiators TVRs set to 3. • Regulate Air conditioning. • Education.

15. Reporting Leaks Hippos Re-use of grey water Save Water

16. Papers and printers • Recycled paper used at all times. • Scrap paper used for note taking. • Printers set to economy and double sided printing. • ‘A’ Energy equipment bought as replacement.

17. Telephone Clinics • Appropriate patients are identified and have telephone appointments during at a dedicated time • Bloods taken by GP • 1st year results • 5709 miles saved • 2.26 tonnes CO2e • £663 saved in reimbursement (more if required hospital transport)

18. Staff Travel • An area that is being tackled in the hospital through The Healthier Working Lives Group. • Changing rooms with showers for cyclists are available • Locked bicycle sheds are available. • NHS GGC initiatives are publicised and staff are made aware. • Car sharing is encouraged.

19. Patient Travel An area that is largely out of my locus of control, HOWEVER… • I can encourage ambulance drivers NOT to leave their engines idling whilst waiting on patients. • I can also pass on any information I receive about greener fleets etc. to the right person • I can discuss green initiatives with the ambulance crew. …a little may just lead to a lot.

20. Low Carbon Shopping • An area that can be tackled by the Renal procurement group. • Shop floor ideas can be escalated to them.

21. Decarbonise Patient Care • An area for the future… Preventative care is always the best kind of care. • Current focus on diabetic feet and diabetic control

22. Barriers to change • Health and safety • Griff bins + new bags • Reusable sharps boxes • Procurement • dressing packs • National contract • Set up renal group to input into tender • Infection control • Need to involve early and keep onside • Saline bag removal • New bags need to be off floor – new sack holder

23. The Future • Ongoing audit to drive improvement • Key Performance Indicators • Consistency of practice • Sharing of ideas and information • Extending to other high resource areas