Pharmacy

This chapter concentrates on community pharmacy and General Practice pharmacist issues. Prescribing issues are covered in Chapter 7. The starting case highlights the anticholinergic burden of drugs and the role of community (and practice) pharmacists in identifying interactions.The size of primary care prescribing (75% of NHS medications) means that this is a key carbon (as well as quality of life and cost) issue when estimates suggest that 10% of medications are unnecessary. The overlap between current good practice and sustainability agendas suggests the importance of weaving sustainability into stories about how to take medications. The role of pharmacists in clinical consultations and reviews, and their use of guides and use of technology to maximise their effectiveness is reviewed.The importance of effective prescribing management systems for repeats or after-hospital care is highlighted. Centre for Sustainable Healthcare’s four principles of sustainable health care suggest how community pharmacies can be better at preventing illness (lifestyle inputs and green social prescribing), empowering patients (personalised care and sick-day rules, multi-compartment compliance aids, medicines disposal, and antimicrobial resistance), designing and delivering leaner service (paperless prescribing, stock management, collection checks) and offering low carbon alternatives (e.g., liquid medication alternatives).Toolkits for greener pharmacy are introduced, and the chapter addresses the importance of pharmacy education programmes, as well as acknowledges the barriers to sustainable pharmacy practice

Improving Antimicrobial Use to Protect the Environment: What Is the Role of Infection Specialists?

Anthropogenic environmental changes are causing severe damage to the natural and social systems on which human health depends. The environmental impacts of the manufacture, use, and disposal of antimicrobials cannot be underestimated. This article explores the meaning of environmental sustainability and four sustainability principles (prevention, patient engagement, lean service delivery, and low carbon alternatives) that infection specialists can apply to support environmental sustainability in health systems. To prevent inappropriate use of antimicrobials and consequent antimicrobial resistance (AMR) requires international, national, and local surveillance plans and action supporting antimicrobial stewardship (AMS). Engaging patients in addressing environmental sustainability, for example through public awareness campaigns about the appropriate disposal of unused and expired antimicrobials, could drive environmentally sustainable changes. Streamlining service delivery may include using innovative methods such as C-reactive protein (CRP), procalcitonin (PCT), or genotype-guided point of care testing (POCT) to reduce unnecessary antimicrobial prescribing and risk of adverse effects. Infection specialists can assess and advise on lower carbon alternatives such as choosing oral (PO) over intravenous (IV) antimicrobials where clinically appropriate. By applying sustainability principles, infection specialists can promote the effective use of healthcare resources, improve care quality, protect the environment, and prevent harm to current and future generations