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Metered Dose Inhaler Use Reduction - Coggle Diagram
Metered Dose Inhaler Use Reduction
Why
Climate change is the biggest health threat facing society
Health care contributes to climate change and Canada has the second most climate intensive system in the world (4.6% of national GHG emissions)
MDIs have been shown to contribute 3.5% of health care emission (due to HFA propellant being 1300x more potent GHG than CO2)
Decreasing MDI usage and utilizing other inhalers would reduce health care's GHG emissions
MDI = 205 kg CO2 equivalents, dry powder inhaler = 7.3 kg CO2e, soft mist inhaler = 9.5 kg CO2e
How
Policy Changes
Change to low volume HFA inhalers on contract
Changing formularies to ensure low emission inhalers listed, restrictions for MDIs
Have a multiuser medication policy for discharge so that inhalers can be sent home with patients and not wasted
Operational Changes
Redesign clinical order sets to remove MDIs and include other otptions
Prioritize inhaler ward stock so MDIs are not available
Tamper seal inhalers so if they are dispensed but not used they can be re-used instead of wasted
Educational Strategy
Inpatients health care providers
Outpatient health care providers
Patients
Resources
CASCADES
Climate Conscious Inhaler Practices in Inpatient Care Playbook
Climate Conscious Inhaler Practices in Outpatient Care Playbook
Climate Resilient, Low Carbon Sustainable Pharmacy Handbook
CAPhE
CAPE
CANE
Coallition for Greener Healthcare
PEACH
Questions to Consider
What is the baseline knowledge of the population
What is the positionally of the population on the issue
Does this align with the priorities of the institution
What baseline information is needed to understand complexities (e.g. what is MDI use at my practice site, is this even a problem)
Where in the supply chain are areas to intervene
What should the goal reduction in use be? (can't be zero)
What intervention is most effective
What level is best to intervene on? (e.g. prescriber level, policy level, operational department like pharmacy)
What barriers can be predicted and planned for?
What data exists to support these interventions
What is the best method to measure use and changes (outcome measures)