September 24, 2025

00:28:36

GOSHpods Goes Green S3 - Episode 3: Using Medicines Well

Hosted by

Emma Forman Dr Rhian Thomas
GOSHpods Goes Green S3 - Episode 3: Using Medicines Well
GOSHpods
GOSHpods Goes Green S3 - Episode 3: Using Medicines Well

Sep 24 2025 | 00:28:36

/

Show Notes

 

In this insightful episode, host Stephen Tomlin—Director of the Children’s Research and Innovation
Centre at Great Ormond Street Hospital and Medicines Sustainability Lead for North Central London
ICB—joins Caroline Dalton from the Medication Information Team at GOSH to explore how digital
innovation and informed prescribing can benefit both patient safety and the environment.
Together, they dive into:
- The digitalisation of prescribing: safer for patients, better for the planet
- Why consistent environmental data on medications matters for clinical decisions
- How medicines optimisation supports sustainable prescribing and improves outcomes
- The power of education and even gamification in helping patients take their medicines well

From practical strategies to forward-thinking ideas, this episode is a must-listen for anyone
passionate about greener healthcare and patient-first innovation.

Listen now and discover how smarter prescribing can lead to a healthier future—for people
and the planet.

Sound effects obtained from https://www.zapsplat.com

View Full Transcript

Episode Transcript

This Podcast is brought to you by the GOSH Learning Academy. [00:00:04] SA: Welcome to the third season of GOSHpods Goes Green. In this season, we're going to be focusing on medicine sustainability. In 2021, Great Ormond Street Hospital was the first UK children's hospital to declare a climate and health emergency. The NHS as an employer is responsible for 4 percent of the UK's total carbon emissions. And medicines are responsible for 25 percent of that. We're going to explore this topic further, taking a journey through the life cycle of a medicine, covering everything from production and procurement, use of medicines in hospitals and homes, all the way through to medicines disposal, to properly explore how we can change the impact that medicines have on the environment. [00:00:45] Stephen: Hello and welcome to the next session that we are doing on medicine sustainability at Great Ormond Street. Today we are covering using medicines well, and with me I have Caroline. Caroline, would you like to just introduce yourself, what you do and why you're doing this? [00:01:05] Caroline: Hi everyone. My name is Caroline Dalton. I work in the medicines information team at Great Ormond Street Hospital. And the reason I'm doing this podcast is well, I feel incredibly passionately about sustainability in every kind of aspect of my life. So particularly if I can bring that into a work environment and help to push us towards a greener NHS, then I'm all here for it. so much. And. [00:01:26] Stephen: Wonderful, I mean that's really good to hear. do need as many champions in this as possible. Obviously today's topic is, it's an interesting title, using medicines well, I hope [00:01:38] Caroline: Our job title, [00:01:39] Stephen: Yeah, it sort of goes with pharmacy, but using medicines well in the sustainability sense, is that the same as using medicines well in a clinical sense, and since it often comes up in pharmacy in the financial sense. What does using medicines well really mean. And do you just wanna open up the topic and tell us what you think about the title. [00:02:01] Caroline: Sure, of course. So, I absolutely think that you and I are pretty aligned on this. We've had a few discussions about this in the past. So, yeah, there are a huge number of direct comparisons that can be drawn with the work that we would already be doing, in medicine's optimisation and using medicines well, in our day to day practices pharmacists that can absolutely be directly translated to using medicines more sustainably, in a kind of sustainable wellness kind of a place. So, we're sort of had a bit of a focus on sustainable prescribing for this episode, I think, haven't we? The reason it's so important is probably said this a number of times on this podcast around 25 percent of the carbon footprint of the NHS is based on medicines, right? It's a stat that we've seen a lot. And it is really so important that pharmacists, no matter where you are, we have an idea of the huge impact that we can have on that, and on the kind of carbon footprint at the NHS. It's important to recognise as well I think that medicines from a kind of, yeah, a greener NHS perspective, we are looking at a carbon target. But there's a great number of other things that could impact the kind of environmental acceptability of a medicine as well. So, really sustainable prescribing for me takes into account all of those things. To try and reduce the overall impact of medicines on the environment. So I know I've seen the RPS (Royal Pharmaceutical Society) has got some really useful information around their kind of position statement on this and something they mentioned is a digitalisation of prescribing. So I think that's a really useful tool that we have already used across a number of NHS trusts. to reduce the kind of paper burden and to optimise prescribing and to make it clearer and safer for our patients. But that also then has an environmental positive impact as well. And then I think, increasingly we're seeing a little bit more in the way of data around the direct impact to the environment of certain medicines, but we need a little bit more clarity on those and a little bit more consistency in how that's measured. So, that I think is going to be something that's hopefully, I mean, if we can see that coming out increasingly over the next kind of months to years, that would definitely, I think, help us as clinicians to decide whether or not, you know, when you bring a new medicine to a hospital formulary, for example, and you're weighing up the kind of clinical impact and the financial impact and the kind of, how well it works in the patient, importantly, as well. Actually bringing an environmental impact assessment into that kind of discussion as well, I think would be a really exciting thing going forward. I think a couple of trusts across the NHS have maybe seen, well, have started to implement a little bit more of that. So I'm excited to see where that goes in the future for sure. [00:04:40] Stephen: I think you're right. There's how we assess the carbon footprint and not just the carbon footprint. As you mentioned, the other environmental factors is not well-defined at the moment, but it's getting there it does, it needs to be alongside finance and everything else put into place, doesn't it, in terms of how do we choose. But if I go back to the start of this, I suppose most medicines, the biggest carbon footprint is from the manufacturer of the medicines themselves. And therefore, it'd be very easy for me to sit here and ask you, well, why do we use medicines? Because if we didn't use them, we wouldn't have a carbon footprint. And if they're such a big problem should we stop using them? Now, obviously. That isn't obtainable not desirable in any shape or form. But we do seem to know that a lot of the medicines that we purchase and a lot that we dispense are never used for all sorts of reasons. And therefore there must be things that we can look at in terms of the way we provide medicines that makes using medicines better a reality. Using them better in my mind seems to be Okay, if we've got to use them, let's use as few as possible and get the best out of them. How do you think we're thinking about that at Great Ormond Street or across the board? [00:06:03] Caroline: Well, I think that's a huge part of, you know, it's kind of our MO, isn't it, as pharmacists to really optimise the use of medicines when they are prescribed, where they are necessary, to have a look at what's already there for this patient. And everyone's a winner in that instance as well, aren't they? So if we have a look at a list of medicines that a patient is taking, actually two of them are doing the same thing. One of them is reducing the side effects of one of the other things that have recently been added in, you know, having a look at whether we can optimise and potentially reduce the pill burden or liquid burden in a lot of our cases then that again, like you say has a direct impact on not only the patient's wellbeing and their overall kind of ability to manage all these different medicines and all the interactions and side effects actually, it does have a direct climate impact as well because you're using less and you're wasting less. So a lot of our medicines are in liquid form, so they can expire once open, so there's a huge issue there around potential for waste, and yeah, absolutely, if you can reduce them from being prescribed in the first place, or optimise in the first place, and that's great idea. And I think we do that quite regularly as pharmacists when we do kind of drug histories, we have to look at the kind of medicines, reconciliation and optimization at that stage to try and yeah, optimise the use of those. [00:07:18] Stephen: Yeah, no, I totally agree. There's, I know the term de prescribing is used quite a lot. And everybody says it's harder to stop somebody's medicines than it is to start them in the first place. But leading that to one side a little bit, you know, that is to do with how reviewing patients appropriately and assessing the need for every medicine. Every time they're looked at. We've obviously got to ensure that we get patients to use their medicines appropriately and we know that a lot of medicines just aren't used for all sorts of reasons or if they are being used, they're not used efficiently. They're taken when the patient feels that they need them, rather than taking them regularly and that sort of thing. We know that not every dose that is prescribed on a label is taken. Yeah, if something's three times a day, it might not always be taken three times a day and these sorts of things. And some of that seems to come down to education. And do you just want to say a little bit about sort of medicines education from your side. You're obviously medicines information and therefore an expert on all the information that's out there. How do you think we can improve that side of things? And obviously, that lovely leaflet which comes in the package [00:08:38] Caroline: Oh, yes. [00:08:39] Stephen: Is another bit of a destruction of their environments? I think I read somewhere that 9, 000, 000 trees are chopped down just putting that information in there. And obviously for children often that information is not appropriate and certainly not in a format that everyone can see. want to talk us through that a little bit? [00:08:55] Caroline: Yeah, absolutely. You're absolutely right. Education is a huge part and kind of counselling and taking people on that journey with you as to why they're taking the medicines in the first place is really so key. So I think really, it's delivering a patient first approach to them, getting a grip on why they're taking these medicines, the importance of taking them, at the right time, at the right dose, and to have quite an honest and open discussion, I find is the most useful way to say, if you were to miss a couple of these, this is what would happen or this, impacts on those, but also to work with patients because this is their, It's really about empowering people, I think, to take ownership over their medicines sometimes. So it's really, getting them to the point where they understand why they're on them, but then working with them around fitting that into their existing lifestyles. I did chat to the young person's forum about this a little bit as well It's putting yourself forward with your medicines. You need to you know, you need to be on them We've got you on them for a good reason We'll have tried to de prescribe wherever possible but we've left you with the bare bones of what is necessary for you to take So, how do you make sure that you take that? Well, and that means something different for everyone so that might be mean that you set, an alarm to take them in the morning, whereas actually if you know that you have lots of things on in the morning and you want to fit that into some other part of your routine, then that's all, all well and good. And it's about, it's about empowering people to take their medicines at a time that suits them, that is also going to clinically fit with how we expect the medicines are going to work best for them essentially, as well. On your point around education and leaflets and delivering the information. Again, that's quite an individualised approach. So, with paediatrics, as our patients grow up, they gain a greater understanding of their medicine. So, you may start to tailor counselling to the patient and to their kind of developmental stage in their life stage. So we know that particularly in early adolescence, perhaps your concrete versus abstract thinking is still developing over time. So, telling adolescent patients, if they don't do this, this will happen. They may not be able to grasp that abstract concept, particularly with a long-term condition. So, it's using the tools that you have available to frame that in a positive way rather than a kind of a, yeah, a punitive, you must take your medicines because otherwise this will happen. [00:11:25] Stephen: Was just going to say on that, I think I'm erring back to my own children and things. I mean, they are creatures of habits, generally, they love routine. And therefore, I think even if a three-year-old knows they're supposed to be doing something, they won't forget and they'll almost do it specifically on time every day. They might not know why and everything else, but if they know it's theirs and therefore just getting all the right stickers involved on their spacer device for their asthma or whatever is probably just as important. [00:11:52] Caroline: Yeah, gamification actually is such a, it's a really useful tool. So, adding things like sticker charts in or, delivering them in a fun and interesting way. So not making it just about the fact that they have to take this medicine at this time, but yeah, kind of bringing that into a more fun kind of a root part of their routine would, is a great way to get that point across. And that, yeah, does develop over time. There is that mandatory patient information leaflet that comes with everything we think that there is probably a better way to deliver that information than just the standard leaflet that is put in with every box. And particularly if you're on this medicine for a long period of time, you will get it with every new box of medicines, which at the moment is a part of our existing legislation. It's got to be there from a legal standpoint to make sure that these patients are getting care. a kind of a piece of information that has been deemed appropriate. But we know that we can do better. So, Steve, I know you and I've touched on this as well. We're developing lots of more fun and interesting, more engaging tools like delivering videos or verbal delivery of information rather than it being on a, tiny little information leaflet that maybe no one reads anyway, or doesn't have a good understanding of what's on there and why that information is on there. [00:13:07] Stephen: Certainly, and I guess that's not just for children, is it? There's something about not everybody is able to read not everybody's able to read English let alone the fact that it's so complex and as you say, so small you've got people who are blind and, then you've got engagement. You know, I'm sure a child would rather have some cartoon chat to them about their medicines than given no 0.8 or whatever size lesser that is, and try and read it. and we need to do far better assets in all formats of information, written, verbal and make sure that people understand. Obviously, a lot of people in the UK may not have English as their first language. I know more people can understand English than read English and all these sorts of things. So, it's really important that we get information formats, right. And rather than just accepting a nod of yes, I understand, ensuring that people understand I think is really important. [00:14:02] Caroline: And there is some quite alarming things on some of these patient information leaflets as well So it's about us being able to pull out the most important information and things like side effects They really have to list all of the side effects on these information leaflets, don't they? So actually we have got a few tailored Leaflets. So still in leaflet form, although we're hoping to develop that into a bit more of an interactive media. Even just optimizing the leaflets to be a little bit more child friendly and a little bit more kind of person friendly really to deliver the key information, the key kind of adverse effects to look out for and side effects. But just really doing that in a more succinct way is what we've tried to do with our patient specific information so far. Yeah, it's all very individualised. And I think it really needs to be led by the person taking the medicines as well. [00:14:53] Stephen: Now, we'd be wrong to be talking about sustainability and about children's medicines and obviously not mention liquids. But I suppose it's in some ways it's a fallacy that every all children need liquids. We know that's not true often we have to use liquids because up until now, it's been one of the only way of titrating to the right dose. It's not the fact that the child needs a liquid. It's the fact that we can't give a dose without having a liquid and drawing up different amounts. And over the last 10 years, there's been a lot of work done around looking at what could be done in terms of reducing the number of liquids. We're obviously looking at this at Great Ormond Street and there's some work, I was involved with many years ago which we published on. But where are we and what do you think we should be doing with liquid medicines? And why are liquid medicines such an issue? [00:15:44] Caroline: So, I think you're alluding to a piece of work that we've done called pill school or kids meds. So it's an initiative that started, I think, was it Newcastle? [00:15:54] Stephen: I think Aston brought pIll school, Newcastle brought out kids meds, but they're the same thing. And I think the thing is, how do we get children to swallow tablet or solid dosage forms? And, I always say it's not the children who can't swallow the dosage forms because we know they can swallow all sorts of solid things from a very young age, but convincing the parents it's the right thing to do is probably the thing. But yeah, where are we on all of this? [00:16:18] Caroline: yeah, we have relatively recently started rolling this out. So we've started having a look at this on some of our cardiac wards. So wards where patients are taking a great number of medicines, and can we potentially switch some of these to solid doses forms? Yeah, so, One of my colleagues who was in the medicines information department and now is in the ITUs, she has essentially, gotten buy in from some of the ward staff and her patients to start to really educate them on why this is a good thing, not only for the environment, but also just looking at long term kind of suitability of these medicines in children. So, encouraging them to swallow solid dosage forms has a great number of benefits. Yes, you can talk about the financial benefits. It's a little bit cheaper. Oftentimes tablets are a little bit cheaper. They don't have the issue of once the bottle has been opened, it will expire after a certain amount of time. Sometimes the excipients in some of these liquid medicines, although they, in theory, are in a formulation. Where they can be swallowed by children more easily. And they may have some really quite nasty excipients in them or excipients that are maybe less desirable over a longer period of time. And also just even practically, carrying around big liquid medicines, to school or on holiday. It can be much more challenging. So, working with both the ward staff, our pharmacy staff and our patients to try and encourage them to swallow through various methods of trial and error. You start from a small jellybean or even smaller, I think even like a tic tac style just get them used to the swallowing and then building right up to a kind of a tablet size formulation. So, that excellent piece of work, started I think it's about six months ago now, was it? And has been incredibly successful. So we are now rolling that out into other areas of the trust as well. [00:18:10] Stephen: So, a takeaway from this would be, if we can move people over to solid dosage forms from liquids, Both from a clinical, a financial, and an environmental point of view, it's the right thing to do. If I was to quote you on what age could we be looking at this from? What would you say? [00:18:29] Caroline: It really depends on the child. So, really any age, when can they start swallowing solid food and work from there? So I've seen four-year-olds swallow tablets with absolutely no problem. We've also seen 14-year-old struggle. So, it really depends, I think you're absolutely right on the attitudes of everyone around them as well as themselves to try and get them to understand why in the long run, it's going to be more useful. They also don't taste of anything, do they? So, if they're on these big doses of liquid medicines, having to chug down 20 mils of, for example, rifampicin, I know tastes horrendous. It's, sometimes so much easier to get into the habit of swallowing tablet. So, yeah, positive reinforcement and encouragement is really key here as well. Everyone kind of being on board with doing that. [00:19:16] Stephen: Wonderful. Thank you. Now, one of the bits of work I believe you did was looking at different routes of administration and, I'm going to quote this very quickly in my own mind from what I remember, it basically said that the oral route from a sustainability point of view, was better than the IV route and that tablets were generally better than liquids. Now, that's a very, huge summary of a big bit of work that you've done, you've touched on the liquid bits. Do you just want to mention what it is you've done and why we should probably be trying to get people off of IVs as well? [00:19:52] Caroline: Yeah, and this is something that again from a medicines optimisation perspective has been, it's not new. And we've just been able to put an additional kind of environmental viewpoint on it. So, we had a look a couple of years ago now, probably actually about the amount of single use plastic that would go into administering a dose of IV paracetamol, and how that would tally up against the equivalent dose orally rectally, and then orally with tablets and liquids. So, yes, we did a big piece of work around that, and did find there are even certain ways to give an IV more sustainably than others. [00:20:30] Stephen: So, is it all to do with plastics and things? If I remember rightly, this wasn't the medicines themselves. This was the different methods of administration. [00:20:39] Caroline: Exactly. [00:20:40] Stephen: We've obviously looked at IV to oral swapping with antimicrobials for a long time. Many hospitals certainly have a process and antimicrobial pharmacists and all these things that do this. How do you think we should potentially move forward with this with other medicines, not just antibiotics, or should we just take the same approach as we've done with antimicrobials? [00:21:04] Caroline: I'd say it's a good approach to take, really just rationalising, not only the medicines that people are on, but how they're taking them is really important. Yeah. So, obviously any IV dose is associated with a greater risk then an oral dose is just in terms of infection prevention control. Also in terms of errors in dosing administration. So, from a patient safety, medicine safety perspective, it's actually better to switch over wherever possible, particularly for medicines that have a high oral bioavailability. We should absolutely be prioritising a switch from IV to oral as soon as possible. There might be some clinical reasons why you can't easily do that. But again, it should be the exception that people are left on IVs than the norm. I think that just again, talking about how we were saying earlier, the parallels around medicines optimisation and better patient outcomes. There is a direct environmental benefit to doing this as well. So, reducing single use plastic, reducing nursing time. They are generally more expensive as well. So, when you have a look at carbon foot printing of a medicine, the kind of easiest way. That we've got to do it at the moment is a direct, top-down approach that we're using the actual cost of the medicine and plugging that into a formula that will give you an estimate of the carbon footprint. So, we did both, we took out the drug because we know that's not probably the best way to look at the proper carbon counting. But we did add that in just for a comparable approach as well and both ends up the same really apart from rectal administration suppository is very expensive and actually if you took out the cost of the medicine, rectal would be the second best to oral with tablets in terms of environmental impact. But yeah, essentially, switching away from IVs over to orals, as soon as clinically possible. It's again it's better all around. It's better for the patient. It's better for the environment. It's better for your bottom line. [00:23:01] Stephen: So, if I'm hearing all of this correctly, it's a win, win, win in some ways when we're looking at best use of medicines for patients. We should be having them on the least number of drugs that they need to be on, making sure that they're only on what they need. And making sure that they're taking them appropriately. By doing that, we might have interactive information, and therefore we can get rid of the paper as well. And then get them off of IVs, which are generally a bad thing if I'm hearing this right. Obviously, if they're needed, but get them onto oral. [00:23:30] Caroline: It can be a very useful thing, but yes there are risks. [00:23:33] Stephen: And get them onto tablets rather than liquids, which are generally cheaper, less messy, more accurate less excipients. [00:23:41] Caroline: Less waste. [00:23:42] Stephen: Less waste, win, win, win, win, win. So I'm loving hearing this and hopefully it gives everybody a bit of a direction forward. I think often we take sustainability out of the equation and think of it as separate, but it's another catalyst for right to care. If I'm hearing you rightly? [00:24:01] Caroline: Yeah, absolutely. [00:24:02] Stephen: Just to finish off, I better ask, is there anything else that's happening at GOSH or across the country in terms of more sustainable use of medicines. Obviously there's the waste, and we're picking that up in another session, but in terms of the actual use of medicines or have we, covered it all? [00:24:20] Caroline: I think, it's probably adding to the work that's already ongoing around making sure that people are using their medicines most effectively. So, we always talk about the most sustainable patient is actually the patient that is kept out of hospital. So it's not about not using medicines. We can't do that. Medicines are incredibly important. They're there for a reason. They genuinely do save and prolong life. So, it's important that we don't see medicines as this big climate crisis that needs to be removed from the system. Absolutely not, medicines have their place and I'm not just saying that because I'm a pharmacist. But what does need to happen is the attitude towards medicines needs to shift in some instances, so It's not only about looking at it from a financial perspective, but it's also having a look at it from an overall environmental perspective of if you're wasting or not using these medicines very well, what are the potential implications? I think the general public are quite clued up on this. I do actually think our patients and people that need to take medicines are pretty clued up on, they need to take their medicines to keep them well, but they also are very conscious that they shouldn't be reordering if they've got enough at home. They should be keeping just enough supply to keep them going, not running out, but not ordering excessive amounts. I think that's something that it's been a piece of work that's been done has been in various different iterations has been at the forefront of medicines optimisation for a long time, particularly in community, pharmacy, and having to return all those unused medicines to a community pharmacy for whatever reason can be quite disparaging. So, Yeah, using medicines well, I think, so the education piece, and we absolutely, as pharmacists a huge part of our roles to make sure that when people are put on to new medicines, they understand why, and I think that is a huge reason that a lot of people are not happy to, or will not take their medicines, they don't understand the implications of why they're on them, they don't understand the impact to themselves or whoever they're looking after to give the medicines to. Why they're on them, why they should take them. So it is really important that we continue our efforts to counsel everyone appropriately as well and make sure that we're really going through and addressing their concerns and understanding them on a personal level, why they may feel that they are not able to take or should not be taking certain medicines and working really on an individual case by case basis around that. And then nationally, I think that there's probably, I think there is something that's going to be coming out of the greener NHS around wider education. So a bit of a education piece on medicines and the environment and making sure that we're keeping you healthy, keeping you well, keeping you out of hospital, taking your medicines properly. This all is tied up in a lovely parcel of sustainability as well. Like you said before, it really is a win, win, if you can take your medicines and they work like they're meant to, you stay out of hospital, you stay well. And we use less in the way of intensive treatments that you often find in hospitals, IVs, respirators these big, long infusions if you're really unwell. So, if you can keep yourself out of hospital better for you, better for the planet, I would say. And that is about taking medicines well. [00:27:33] Stephen: As you say, if we get this right, caring for patients appropriately with medicines is a win win clinical, financial, and definitely the environment. It's been an absolute pleasure talking to you. Thank you very much, Caroline. [00:27:47] Caroline: Thanks so much for having me. [00:27:49] SA: Thank you for listening to this episode of GOSH Pods Goes Green. We would love to get your feedback on the podcast and any ideas you may have for future episodes. You can find a link to the feedback page in the episode description or email us at [email protected]. If you want to find out more about the work of the GOSH Learning Academy, you can find us on social media on Twitter, Instagram, and LinkedIn. You can also visit our website at www.gosh.nhs.uk and search Learning Academy. We have lots of exciting new podcasts coming soon, so make sure you're subscribed wherever you get your podcasts. We hope you enjoy this episode and we'll see you next time. Goodbye.

Other Episodes