1. Green Nephrology Renal Dialysis Unit Vale of Leven Leigh Bainbridge leighbainbridge@nhs.net

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

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

4. Waste Management Project

5. How we made the change… High level engagement High level engagement Identify ground level link nurses Identify ground level link nurses Asked for help Asked for help Initial meeting Initial meeting –Existing practice –Areas of opportunity –Identify first steps –Possible barriers Audit and do! 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 WASTE STREAMING SAVINGS COST SAVINGS£14,318 / yr CO2e80 tonnes/yr

9. Savings-cost and carbon emissions from safe elimination of equipment GRIFF BINS – 14,000 / yr GRIFF BINS – 14,000 / yr £92,592 saved /yr £92,592 saved /yr –£84,000 buy –£8,592 dispose Approx 43 tonnes CO2e Approx 43 tonnes CO2e Discontinued use early 2012 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 CO2 Resource Efficiency Tool Tool employed to carry out effective action planning. Tool employed to carry out effective action planning. Energy/ Environmental/ Waste walkabout Energy/ Environmental/ Waste walkabout Available from the Centre for Sustainable Healthcare website under the Green Nephrology section Available from the Centre for Sustainable Healthcare website under the Green Nephrology section Submission and evaluation of action planning Submission and evaluation of action planning SO, what are we doing? SO, what are we doing?

12. Reduce, Re-use, Re-cycle Reduce: Waste Reduction Project (quick wins) Reduce: Waste Reduction Project (quick wins) patients bring own blankets Re-use:Creative uses for objects Re-use:Creative uses for objects e.g. Gallipots Examining practice Re-cycle: Printer cartridges 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. More can be done…Equipment freecycling, food wastage, sharps box re-usage.

13. Lighting Stickers and Posters from the Carbon Trust Stickers and Posters from the Carbon Trust www.carbontrust.co.uk www.carbontrust.co.ukwww.carbontrust.co.uk Ensured that all our light bulbs are replaced with energy efficient ones Ensured that all our light bulbs are replaced with energy efficient ones Liaised with estates to ensure old light bulbs are recycled. Liaised with estates to ensure old light bulbs are recycled. Motion sensors in place in appropriate areas 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. 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. Posters from The Carbon Trust. Radiators TVRs set to 3. Radiators TVRs set to 3. Regulate Air conditioning. Regulate Air conditioning. Education. Education.

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

16. Papers 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 sided printing. Printers set to economy and double sided printing. ‘A’ Energy equipment bought as replacement. ‘A’ Energy equipment bought as replacement.

17. Telephone Clinics Appropriate patients are identified and have telephone appointments during at a dedicated time Appropriate patients are identified and have telephone appointments during at a dedicated time Bloods taken by GP Bloods taken by GP 1 st year results 1 st 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. An area that is being tackled in the hospital through The Healthier Working Lives Group. Changing rooms with showers for cyclists are available Changing rooms with showers for cyclists are available Locked bicycle sheds are available. Locked bicycle sheds are available. NHS GGC initiatives are publicised and staff are made aware. NHS GGC initiatives are publicised and staff are made aware. Car sharing is encouraged. Car sharing is encouraged.

19. Patient Travel An area that is largely out of my locus of control, HOWEVER… 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 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 also pass on any information I receive about greener fleets etc. to the right person I can discuss green initiatives with the ambulance crew. 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. An area that can be tackled by the Renal procurement group. Shop floor ideas can be escalated to them. 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. An area for the future… Preventative care is always the best kind of care. Current focus on diabetic feet and diabetic control Current focus on diabetic feet and diabetic control

22. Barriers to change Health and safety Health and safety –Griff bins + new bags –Reusable sharps boxes Procurement Procurement –dressing packs –National contract –Set up renal group to input into tender Infection control 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 Ongoing audit to drive improvement Key Performance Indicators Key Performance Indicators Consistency of practice Consistency of practice Sharing of ideas and information Sharing of ideas and information Extending to other high resource areas Extending to other high resource areas