Environmental sustainability in medication processes performed in hospital nursing care

Furukawa, Patricia de Oliveira; Cunha, Isabel Cristina Kowal Olm; Pedreira, Mavilde da Luz Gonçalves; Marck, Patricia Beryl

doi:10.1590/1982-0194201600044

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Acta Paulista de Enfermagem

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Original Article • Acta Paul Enferm. 29 (3) • May-Jun 2016 • https://doi.org/10.1590/1982-0194201600044 copy

Environmental sustainability in medication processes performed in hospital nursing care

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Sustainable actions performed by the nursing team in an intensive care unit during medication processes were examined, after which interventions were proposed to improve environmental sustainability in the hospital setting.

Methods

Before and after study, using the Lean Six Sigma methodology applied in an intensive care unit. The sample was comprised of 648 medication processes performed by the nursing team. The data was collected via observation routes and analyzed quantitatively.

Results

The post-intervention results included: reduction of materials such as plastic bags (37.1%), reduction of hormonal anti-inflammatory drugs (67.1%), increased removal of labels from plastic bags to be recycled (146.9%) and proper waste disposal (32.2%), with a statistically significant difference (p ≤0.05).

Conclusion

The intervention strategies implemented, based on an analysis of the problem, validation and prioritization of the actions had a positive influence on reduction, recycling and proper disposal of waste with benefits for the institution, environment and human health.

Nursing service; hospital; Nursing process; Environment; Waste management

Stages of the process and interventions	Pre intervention	Post intervention	p-value
Withdrawal of medication
Reduce: use of plastic bags for transporting medications	41.8	26.3	0.02**
Reuse: plastic bags stored for reuse	19.6	28	0.417**
Recycle and discard properly: disposal of plastic bags	91.8	90.9

Preparation of medications
Reduce: hormonal anti-inflammatory drug leftovers	78.9	25.9	0.001**
Recycle and discard correctly:
Removal of labels from plastic bags to be recycled	32.4	80	0.000**
Proper disposal of plastic bags	95	97.7	0.145**
Proper disposal of materials with little or no organic material (cotton, gauze and other)	25.8*	72.6	0.000**
Proper disposal of primary packaging (syringes)	63.6	84.4	0.002**
Proper disposal of primary packaging (needles)	80	87.5	0.466**
Proper disposal of primary packaging (vials)	64.3	93.8	0.000**
Proper disposal of primary packaging (bottle-vials)	36	89.6	0.000**
Proper disposal of primary packaging (wrappings)	9.52	35.9	0.001**
Proper disposal of hormonal anti-inflammatory drugs	11.1	84.6	0.000**

Administration of Medications
Recycle and discard properly:
Proper disposal of materials with little or no organic material (gloves, masks and caps)	45.2*	88.5	0.000**
Proper disposal of primary packaging (syringes)	55.4	78.9	0.000**
Proper disposal of primary packaging (needles)	54.6	93.1	0.000**
Proper disposal of primary packaging (bottle-vials)	32.1	50.9	0.000**
Proper disposal of primary packaging (plastic bottles)	66.6	47.6	0.459**

Type of waste	Interventions		Results (%)	p-value^**
Type of waste	Before*	After^*	Results (%)	p-value^**
Infectious and sharps	8.76	3.51	-59.94	0.000
Chemical	0.001	0.6	>100	0.000
Normal non-recyclable	3.76	3.06	-18.62	0.002
Normal recyclable	1.19	1.24	+4.2	0.645
Total	13.7	8.41	-38.6	0.000

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author. Patricia de Oliveira Furukawa. Napoleão de Barros street, 754, 04024-002, São Paulo, SP, Brazil. patricia.furukawa@unifesp.br