NMS 2023

The future of medicines, good for people, good for the planet.

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Overview

The future of medicines, good for people, good for the planet

In Australia in 2023, health care contributed close to 7% of our nation’s greenhouse gases, with medicines being one of the largest contributors. Pharmaceutical waste throughout the global supply chain can lead to environmental, human, and animal toxicities, and in the case of antibiotic residues.

Hosted for the first time by the Australian Commission on Safety and Quality in Health Care on 8 November 2023. NMS23 brought together leading organisations, experts, clinicians, consumers, and policymakers in a timely discussion on emerging and key issues around sustainability and the quality use of medicines.

Session recordings

Session 1

A case for change – how appropriate use of medicines contributes to a sustainable healthcare system and planet

In Australia, health care contributes close to 7% of our nation’s greenhouse gases, with medicines being one of the largest contributors. Pharmaceutical waste throughout the global supply chain can lead to environmental, human, and animal toxicities, and in the case of antibiotic residues, to antimicrobial resistance.

Delivering environmentally sustainable and adaptable health services is critical for all sectors and an important national priority. Incorporating sustainable practices in healthcare settings, including the appropriate use of medicines can improve the safety and quality of care, improve the health of the community, reduce low value care, unwarranted variation and reduce waste.

In this session you will hear about the importance of appropriate use of medicines and its relevance to sustainability for individual, community, national and global perspectives.

Keynote Speakers:

Welcome to Country

Ms Yvonne Weldon AM, Metropolitan Local Aboriginal Land Council

Introduction with Master of Ceremonies

Ms Tegan Taylor, Journalist and Broadcaster

Welcome Address

Senator the Hon Malarndirri McCarthy, Assistant Minister for Indigenous Health and Assistant Minister for Indigenous Australians

Welcome Address: Introducing quality use of medicines (QUM) and the link to sustainability 

Conjoint Professor Anne Duggan, Chief Executive Officer, ACSQHC

How is the Australian Commission on Safety and Quality in Health Care meeting the challenge of sustainability in health care? Professor Anne Duggan, the Commission’s CEO, delivers the Welcome Address, and explains how the Commission is driving sustainability across several work areas. The National Standards Environment and Sustainability Climate Resilience Healthcare Module, an important initiative of the Commission, is under development and planned for release in 2024. Professor Duggan emphasises the importance of reducing low-value care and improving the quality use of medicines, and how they are connected to health care sustainability.

Safety, quality and sustainability in medicines

Professor Paul Kelly, Chief Medical Officer, Department of Health and Aged Care

When does good climate policy become good public health policy? In this keynote session, Professor Paul Kelly highlights the scale of the climate change crisis and its impact on the health and wellbeing of Australians. Professor Kelly provides an update on the Government’s first National Health and Climate Strategy, and explains how the strategy should encourage the provision of value-based care and help transition Australia to net zero carbon emissions by 2050. Australia’s health system needs to become sustainable, climate resilient and fit for the needs of generations to come.

Approach to medicines and health system sustainability in the United Kingdom

Professor Nick Watts, Director, Centre for Sustainable Medicine, National University of Singapore

How can we deliver quality care now, and for future generations? Professor Watts describes the UK NHS’s target to transition to net zero by 2045. The NHS have invested into making its energy consumption, patient and staff transport, and supply chains more efficient. In a decade the NHS will no longer purchase from anyone who does not meet or exceed their target. Professor Watts explains that there are often lower carbon alternatives to medicines currently in use, which are cost equivalent or cheaper, and clinically equivalent or superior.

Medicines, health and environmental sustainability: the consumer perspective

Dr Elizabeth Deveny, Chief Executive Officer, Consumers Health Forum

Is prevention better than a cure when it comes to sustainability? Dr Elizabeth Deveny provides consumers’ perspectives on medicines and sustainability, and talks about single-use products, pharmaceutical waste from packaging, unused medicines, and low levels of recycling in health care. Dr Deveny discusses the role of quality use of medicines in attaining better health outcomes, waste reduction and environmental sustainability. The link between climate change and the healthcare system is discussed, and the importance of disease prevention is explained. If we focus on disease prevention rather than curing disease, we will use less medicines, and people will have better health outcomes and life journeys.

Interactive Q&A Session: Improving sustainability in practice

Ms Tegan Taylor, Journalist and Broadcaster

Conjoint Associate Professor Carolyn Hullick, Emergency Physician and Chief Medical Officer, ACSQHC

Session 2

Medicines and appropriate care in practice

What can be done to drive more appropriate care in practice? Australia’s health care system contributes close to 7% of our national carbon emissions, with pharmaceuticals accounting for almost 20% of that carbon footprint. As we face the unprecedented challenge of climate change, it is also estimated that about 30% of health care is wasteful or low value, and a further 10% is harmful.

Reducing low value care including overdiagnosis, over testing and inappropriate prescribing has the potential to vastly reduce carbon emissions and improve health outcomes for patients and the efficiency and environmental sustainability of the health system.

In this session, you will hear about the size of the problem of inappropriate use of medicines and low value care, benefits of good medicines stewardship and practical approaches to achieving appropriate care in practice and better health and environmental outcomes for all.

Keynote Speakers:

Overdiagnosis, overtreatment and low value care

Professor Paul Glasziou, Professor of Evidence-Based Medicine, Bond University

What is low-value care, and where is it happening? Professor Paul Glasziou addresses the ‘60:30:10 challenge’ of evidence-based healthcare. These ratios represent the proportion of health care estimated to be evidence-based, low-value and harmful, respectively. Strategies to reduce antibiotic use for acute respiratory infections are discussed in relation to their uptake by GPs, and an approach that combines different interventions is presented. Comparative data on antibiotic prescribing in Sweden are shown, where around three-times fewer people were dispensed antibiotics in 2014. Although over testing and over treatment in Australia is common, data suggest that change is possible.

Harnessing medicine stewardship for sustainability

Associate Professor Liz Marles, Clinical Director, ACSQHC and General Practitioner, Hornsby-Brooklyn GP Unit

How can medicines stewardship, quality use of medicines (QUM) and appropriate care contribute to sustainability? Professor Marles discusses the inappropriate use of proton pump inhibitors from an individual, community and environmental perspective. The benefits of adopting a comprehensive approach to medicines stewardship is highlighted, with a focus on where QUM fits within the National Medicines Policy. The Commission’s resources are showcased, including the Clinical Care Standards, the National Baseline Report on QUM, and stewardship programs for antimicrobials, opioids, antipsychotics and anticoagulants. It is our responsibility as health professionals, policymakers and individuals to work towards a sustainable future.

The future of medicines: good for people, good for the planet

Dr Kate Charlesworth, Medical Director, Climate Risk and Net Zero Unit, NSW Ministry of Health

Should climate change be considered a health issue? Dr Kate Charlesworth discusses the link between climate change and health care, using recent environmental disasters as case studies. Current policies and regulatory requirements that support sustainable health systems are presented, including the Government’s National Health and Climate Strategy and the Commission’s Sustainable Healthcare Module. The carbon footprint of health care is presented, alongside NSW Health data from the Nepean Hospital. Dr Charlesworth highlights the importance of deprescribing and recycling, and introduces the Australian Deprescribing Network and net zero clinical programs.

Panel Discussion: What can be done to drive more appropriate prescribing in practice?

Professor Alexandra Barratt, Professor of Public Health, University of Sydney

Mr Tim Perry, Consultant Pharmacist

Dr Brett Montgomery, General Practitioner and School of Medicine, University of Western Australia

The panel discussion will focus on safe and appropriate prescribing and some of the drivers for inappropriate prescribing in practice. Panellists will discuss overdiagnosis and over-testing as some of the key challenges to appropriate prescribing using Vitamin D testing, ADHD diagnosis in children and COPD diagnosis as case studies. The panel will discuss the use of a patient centred approach and the use of non-pharmacological interventions including lifestyle interventions, social prescribing and nature prescribing to optimise safe and appropriate prescribing. Attendees will hear about the importance of supporting innovative models and approaches at a heath-system level for achieving behaviour changes in individuals and optimising the safe and quality use of medicines, including embedding pharmacists or nurse practitioners in general practice.

Interactive Q&A Session: Sustainability of Antimicrobials 

Ms Tegan Taylor, Journalist and Broadcaster

Ms Kristin Xenos, Pharmacist and Senior Project Officer, ACSQHC

Lightning Talks

Lightning talks on Opioid Stewardship in Australia

Opioid analgesics are high-risk medicines, widely used in hospitals and primary care to manage pain. In April 2020, the TGA engaged the Commission to develop a framework for a National Opioid Analgesic Stewardship program, and an accompanying clinical care standard, which together support the opioid analgesic regulatory changes. The aim of the TGA regulatory changes, the National Opioid Analgesics Stewardship program and the accompanying clinical care standard is to minimise the risk of harm associated with opioid analgesic use.

The lightning talks at NMS 2023 showcase opioid stewardship in Australia including the Commissions work on opioid analgesic stewardship and research and findings related to the safe and appropriate use of post-surgical opioids, reducing unwarranted variation in opioid dispensing/prescribing, opioid deprescribing guidelines, and how quality use of opioids can contribute to sustainability and reduce carbon footprint of medicines and healthcare.

Presentations:

A practical guide: Using the Atlas of Healthcare Variation to identify variation in opioid medicines dispensing in your local area Mr Myu Arumuganathan, Data Reporting Strategy Manager, Healthcare Variation, ACSQHC
Opioid analgesic stewardship in Acute Pain Clinical Care Standard Mr Steve Waller, Senior Project Officer, Medication without harm, ACSQHC
Perioperative opioid stewardship programs and post-surgical discharge opioid prescribing Dr Megan Allen, Anaesthetist, Royal Melbourne Hospital and The University of Melbourne
Opioid type and persistent postoperative opioid use Mr Evan Michell, St Vincent’s Clinical School, UNSW Medicine
Evidence based clinical practice guidelines for deprescribing opioids Dr Aili Langford, Research Fellow, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University
Pre-transplant opioid use and lung transplant outcomes Dr Christian Haron, The School of Medicine Sydney, The University of Notre Dame Australia and St. Vincent’s Hospital, Sydney

Session 3

Carbon footprint of medicines – improving sustainability across the medicine lifecycle for better health

What can be done to reduce carbon footprint of medicines and minimise pharmaceutical waste?

Most people might not guess but pills (or creams, patches, and inhalers, for that matter) have a big impact on the environment. Within our health care system, medicines are one of the largest line-item contributor to greenhouse gas emissions. In addition, pharmaceutical waste throughout the global supply chain can lead to environmental, human and animal toxicities, and in the case of antibiotic residues, to antimicrobial resistance (aka “superbugs”).

Many of these medicines are lifesaving, offering us enormous benefits and healthier lives when taken correctly. But with some thought, there may be a few things we can do to reduce their carbon footprint and minimise pharmaceutical waste, while keeping good health front and centre.

This session will focus on greener pharmaceuticals and practical ways to reducing carbon footprint across the medicine lifecycle (from manufacturing to waste disposal) while maintaining appropriate care.

Keynote Speakers:

Sustainability in medicines as a global priority

Associate Professor Alpana Mair, Head of Effective Prescribing and Therapeutics, Scottish Government and Senior Consultant, WHO

Our population is aging, but did you know that multi-morbidity and polypharmacy are more common as we get older? Dr Alpana Mair discusses medicine sustainability, with a focus on the safety and environmental burden of polypharmacy. In Europe, 8.6 million hospital admissions each year are due to adverse drug reactions. The majority of preventable admissions are seen in people aged over 65 years who are taking at least 5 medicines. Dr Mair explores medicine safety at different points in the patient pathway and introduces tools and resources developed by NHS Scotland to address medicine safety, polypharmacy, inappropriate prescribing and sustainability.

The carbon footprint of pharmaceuticals: Why is QUM so important?

Dr Forbes McGain, Anaesthetist and Intensive Care Physician, Western Health, Melbourne and Associate Professor, Sustainable Healthcare, University of Melbourne

Did you know that inhalers may have a larger carbon footprint than food waste? Dr Forbes McGain discusses the carbon footprint of anaesthetic gases, labour analgesics and respiratory inhalers, and highlights the importance of quality use of medicines from an individual, financial, societal and environmental perspective. Dr McGain describes the concept of cradle-to-gate greenhouse gas emissions for pharmaceuticals and showcases his work around the lifecycle assessment of morphine – from opium poppy farming in Tasmania through to packaging.

Climate-conscious care of respiratory diseases

Dr Valeria Stoynova and Dr Celia Culley, CASCADES, Centre for Sustainable Health Systems

What is the single greatest threat to human health in the 21st century? Dr Valeria Stoynova and Dr Celia Culley discuss the environmental impact of inhaler therapy and showcase climate-conscious patient education and prescribing tools. They take a stepwise look at the Climate Conscious Inhaler Prescribing Sustainability Pathway, discuss key data illustrating inappropriate inhaler prescribing, and introduce Choosing Wisely Canada’s recommendations on respiratory medicines. When thinking sustainably, health professionals need to consider inhaler type, inhaler technique, and whether there is an alternative inhaler with a lower carbon footprint.

Panel Discussion: What can be done to reduce carbon footprint of medicines and minimise pharmaceutical waste?

Dr Eugenie Kayak, Doctors for the Environment Australia

Ms Grace Wong, Pharmacists for the Environment Australia

The panel discussion will focus on the carbon footprint of medicines from manufacturing to waste disposal. Panellists will discuss medicine manufacturing process and the impact on the environment and note how health services can ensure that pharmaceutical manufacturers and suppliers improve their sustainability commitments. The panel will note the low level of awareness among health care practitioners regarding the carbon footprint of medicines being prescribed in practice. Attendees will hear about the importance of measuring carbon footprint of medicines and the environmental impact of medicines and the opportunities that this exercise can provide to identify potential carbon hotspots that could be addressed. The panel will discuss the issue of pharmaceutical waste and will highlight practical ways to recycling and reducing waste at an individual patient or health practitioner level and collectively at a national level, using blister packaging of medicines as an example. The panel will emphasize policies and strategies that are currently in place or being developed that will drive quality and sustainable use of medicines and health system sustainability as a whole.

Interactive Q&A Session: Environmental Sustainability and Climate Resilience Healthcare Module in development

Ms Tegan Taylor, Journalist and Broadcaster

Mr James Katte, Manager Sustainable Healthcare, National Standards, ACSQHC

Session 4

Thinking differently – innovative approaches to drive sustainable and quality use of medicines

Sustainability is a global challenge, that can only be overcome by taking responsibility and joining forces. Given the multifactorial causes of pharmaceutical waste, no single intervention is sufficient to overcome the problem and thus a multitude of approaches is needed.

Multiple stakeholders of the pharmaceutical chain at various stages of the medicine lifecycle including manufacturing, supply, prescribing, dispensing and use of medicines can contribute to minimising pharmaceutical waste. Digital health technologies can also promote the appropriate use of medicines and contribute to sustainability. Consumer awareness needs to be increased around preventative and lifestyle interventions, safe and quality use of medicines and strategies and approaches to pharmaceutical waste minimization and waste disposal interventions.

This session will explore technologies and innovative approaches to drive positive change towards sustainable and quality use of medicines.

Keynote Speakers:

What can consumers do to support environmental sustainability of health care?

Ms Darlene Cox, Executive Director, Health Care Consumers’ Association

How many tonnes of plastic and aluminium can be recovered from 2.7 million recycled blister packs? Ms Darlene Cox discusses the environmental sustainability of health care from a consumer perspective, and identifies actions that can be taken today to reduce the carbon footprint of medicines and health care. Ms Cox talks through examples of different blister pack recycling programs, Choosing Wisely Australia recommendations, and the Commission’s Sustainability Healthcare Module. Green and blue space interventions as alternatives to medicines are also discussed.

How digital health technologies promote the appropriate use of medicines and contribute to sustainability

Dr Paul Miles, Director eHealth and Medication Safety, ACSQHC

How can digital technology support medication safety and sustainability? Dr Paul Miles highlights the current array of digital health solutions, and discusses the benefits, challenges, drivers and opportunities for digitally enabled care. Digitally enabled systems for procurement, inventory management, and reporting for quality improvement can lead to more efficient medicine storage, more appropriate use of medicines, and a reduction in low-value prescribing and waste. Dr Miles also introduces the Commission’s digital health resources, including electronic medication management systems, real-time prescription monitoring, electronic prescribing (e-scripts), My Health Record and electronic medication charts.

Quality Use of Medicines – sustainable systems

Professor Faye McMillan AM, Community Pharmacist, Deputy National Rural Health Commissioner, Professor in Indigenous Health, UTS

Did you know that the Office of the National Rural Health Commissioner aims to improve the quality and sustainability of access to health services and health professionals in regional, rural, and remote Australia? Professor Faye McMillan explains the focus of the Office, and discusses the value of health workforces that represent the communities they serve. Professor McMillan talks about the Federation of International Pharmacists and Leaders in Indigenous Pharmacy Profession Education Network, and discusses standards to ensure quality training for pharmacists wanting to expand their scope of practice.

Panel Discussion: Projects and case studies that could be opportunities to scale

Dr Emma-Leigh Synnott, Medical Advisor, Sustainable Development Unit, Western Australia Department of Health

Ms Toni Riley, Pharmacist – RUM Project

Professor Branwen Morgan, Minimising Antimicrobial Resistance Mission (AMR) Lead at CSIRO

The panel will discuss innovative approaches to drive positive change towards sustainable and quality use of medicines. Panellists will discuss the use of non-pharmacological approaches to reducing the use of medicines and improve patient outcomes, including preventative and lifestyle interventions and social prescribing. Attendees will hear about the Return Unwanted Medicines (RUM) project and the need for raising awareness and driving uptake of the RUM program. The panel will highlight green procurement, manufacturing and supply chains, particularly in the context of antimicrobials and single use plastics. Attendees will hear about innovative technologies with great opportunities for scale up, to support quality and sustainable use of antimicrobials. Panellists will discuss approaches to handling pharmaceutical waste disposal, including antimicrobial waste. The panel will emphasize the need for embedding messaging in health policy and supporting collective action to drive positive change for our people and our planet.

Interactive Q&A Session: Sustainable prescribing in general practice

Ms Tegan Taylor, Journalist and Broadcaster

Dr Lee Fong, General Practitioner, Hunter New England and Medical Advisor, ACSQHC

Closing Address

Professor Villis Marshall AC, Chair of the Board of the ACSQHC

Close with Master of Ceremonies

Ms Tegan Taylor, Journalist and Broadcaster

Session 1

A case for change – how appropriate use of medicines contributes to a sustainable healthcare system and planet

In Australia, health care contributes close to 7% of our nation’s greenhouse gases, with medicines being one of the largest contributors. Pharmaceutical waste throughout the global supply chain can lead to environmental, human, and animal toxicities, and in the case of antibiotic residues, to antimicrobial resistance.

Delivering environmentally sustainable and adaptable health services is critical for all sectors and an important national priority. Incorporating sustainable practices in healthcare settings, including the appropriate use of medicines can improve the safety and quality of care, improve the health of the community, reduce low value care, unwarranted variation and reduce waste.

In this session you will hear about the importance of appropriate use of medicines and its relevance to sustainability for individual, community, national and global perspectives.

Keynote Speakers:

Welcome to Country

Ms Yvonne Weldon AM, Metropolitan Local Aboriginal Land Council

Introduction with Master of Ceremonies

Ms Tegan Taylor, Journalist and Broadcaster

Welcome Address

Senator the Hon Malarndirri McCarthy, Assistant Minister for Indigenous Health and Assistant Minister for Indigenous Australians

Welcome Address: Introducing quality use of medicines (QUM) and the link to sustainability 

Conjoint Professor Anne Duggan, Chief Executive Officer, ACSQHC

How is the Australian Commission on Safety and Quality in Health Care meeting the challenge of sustainability in health care? Professor Anne Duggan, the Commission’s CEO, delivers the Welcome Address, and explains how the Commission is driving sustainability across several work areas. The National Standards Environment and Sustainability Climate Resilience Healthcare Module, an important initiative of the Commission, is under development and planned for release in 2024. Professor Duggan emphasises the importance of reducing low-value care and improving the quality use of medicines, and how they are connected to health care sustainability.

Safety, quality and sustainability in medicines

Professor Paul Kelly, Chief Medical Officer, Department of Health and Aged Care

When does good climate policy become good public health policy? In this keynote session, Professor Paul Kelly highlights the scale of the climate change crisis and its impact on the health and wellbeing of Australians. Professor Kelly provides an update on the Government’s first National Health and Climate Strategy, and explains how the strategy should encourage the provision of value-based care and help transition Australia to net zero carbon emissions by 2050. Australia’s health system needs to become sustainable, climate resilient and fit for the needs of generations to come.

Approach to medicines and health system sustainability in the United Kingdom

Professor Nick Watts, Director, Centre for Sustainable Medicine, National University of Singapore

How can we deliver quality care now, and for future generations? Professor Watts describes the UK NHS’s target to transition to net zero by 2045. The NHS have invested into making its energy consumption, patient and staff transport, and supply chains more efficient. In a decade the NHS will no longer purchase from anyone who does not meet or exceed their target. Professor Watts explains that there are often lower carbon alternatives to medicines currently in use, which are cost equivalent or cheaper, and clinically equivalent or superior.

Medicines, health and environmental sustainability: the consumer perspective

Dr Elizabeth Deveny, Chief Executive Officer, Consumers Health Forum

Is prevention better than a cure when it comes to sustainability? Dr Elizabeth Deveny provides consumers’ perspectives on medicines and sustainability, and talks about single-use products, pharmaceutical waste from packaging, unused medicines, and low levels of recycling in health care. Dr Deveny discusses the role of quality use of medicines in attaining better health outcomes, waste reduction and environmental sustainability. The link between climate change and the healthcare system is discussed, and the importance of disease prevention is explained. If we focus on disease prevention rather than curing disease, we will use less medicines, and people will have better health outcomes and life journeys.

Interactive Q&A Session: Improving sustainability in practice

Ms Tegan Taylor, Journalist and Broadcaster

Conjoint Associate Professor Carolyn Hullick, Emergency Physician and Chief Medical Officer, ACSQHC

Session 2

Medicines and appropriate care in practice

What can be done to drive more appropriate care in practice? Australia’s health care system contributes close to 7% of our national carbon emissions, with pharmaceuticals accounting for almost 20% of that carbon footprint. As we face the unprecedented challenge of climate change, it is also estimated that about 30% of health care is wasteful or low value, and a further 10% is harmful.

Reducing low value care including overdiagnosis, over testing and inappropriate prescribing has the potential to vastly reduce carbon emissions and improve health outcomes for patients and the efficiency and environmental sustainability of the health system.

In this session, you will hear about the size of the problem of inappropriate use of medicines and low value care, benefits of good medicines stewardship and practical approaches to achieving appropriate care in practice and better health and environmental outcomes for all.

Keynote Speakers:

Overdiagnosis, overtreatment and low value care

Professor Paul Glasziou, Professor of Evidence-Based Medicine, Bond University

What is low-value care, and where is it happening? Professor Paul Glasziou addresses the ‘60:30:10 challenge’ of evidence-based healthcare. These ratios represent the proportion of health care estimated to be evidence-based, low-value and harmful, respectively. Strategies to reduce antibiotic use for acute respiratory infections are discussed in relation to their uptake by GPs, and an approach that combines different interventions is presented. Comparative data on antibiotic prescribing in Sweden are shown, where around three-times fewer people were dispensed antibiotics in 2014. Although over testing and over treatment in Australia is common, data suggest that change is possible.

Harnessing medicine stewardship for sustainability

Associate Professor Liz Marles, Clinical Director, ACSQHC and General Practitioner, Hornsby-Brooklyn GP Unit

How can medicines stewardship, quality use of medicines (QUM) and appropriate care contribute to sustainability? Professor Marles discusses the inappropriate use of proton pump inhibitors from an individual, community and environmental perspective. The benefits of adopting a comprehensive approach to medicines stewardship is highlighted, with a focus on where QUM fits within the National Medicines Policy. The Commission’s resources are showcased, including the Clinical Care Standards, the National Baseline Report on QUM, and stewardship programs for antimicrobials, opioids, antipsychotics and anticoagulants. It is our responsibility as health professionals, policymakers and individuals to work towards a sustainable future.

The future of medicines: good for people, good for the planet

Dr Kate Charlesworth, Medical Director, Climate Risk and Net Zero Unit, NSW Ministry of Health

Should climate change be considered a health issue? Dr Kate Charlesworth discusses the link between climate change and health care, using recent environmental disasters as case studies. Current policies and regulatory requirements that support sustainable health systems are presented, including the Government’s National Health and Climate Strategy and the Commission’s Sustainable Healthcare Module. The carbon footprint of health care is presented, alongside NSW Health data from the Nepean Hospital. Dr Charlesworth highlights the importance of deprescribing and recycling, and introduces the Australian Deprescribing Network and net zero clinical programs.

Panel Discussion: What can be done to drive more appropriate prescribing in practice?

Professor Alexandra Barratt, Professor of Public Health, University of Sydney

Mr Tim Perry, Consultant Pharmacist

Dr Brett Montgomery, General Practitioner and School of Medicine, University of Western Australia

The panel discussion will focus on safe and appropriate prescribing and some of the drivers for inappropriate prescribing in practice. Panellists will discuss overdiagnosis and over-testing as some of the key challenges to appropriate prescribing using Vitamin D testing, ADHD diagnosis in children and COPD diagnosis as case studies. The panel will discuss the use of a patient centred approach and the use of non-pharmacological interventions including lifestyle interventions, social prescribing and nature prescribing to optimise safe and appropriate prescribing. Attendees will hear about the importance of supporting innovative models and approaches at a heath-system level for achieving behaviour changes in individuals and optimising the safe and quality use of medicines, including embedding pharmacists or nurse practitioners in general practice.

Interactive Q&A Session: Sustainability of Antimicrobials 

Ms Tegan Taylor, Journalist and Broadcaster

Ms Kristin Xenos, Pharmacist and Senior Project Officer, ACSQHC

Lightning Talks

Lightning talks on Opioid Stewardship in Australia

Opioid analgesics are high-risk medicines, widely used in hospitals and primary care to manage pain. In April 2020, the TGA engaged the Commission to develop a framework for a National Opioid Analgesic Stewardship program, and an accompanying clinical care standard, which together support the opioid analgesic regulatory changes. The aim of the TGA regulatory changes, the National Opioid Analgesics Stewardship program and the accompanying clinical care standard is to minimise the risk of harm associated with opioid analgesic use.

The lightning talks at NMS 2023 showcase opioid stewardship in Australia including the Commissions work on opioid analgesic stewardship and research and findings related to the safe and appropriate use of post-surgical opioids, reducing unwarranted variation in opioid dispensing/prescribing, opioid deprescribing guidelines, and how quality use of opioids can contribute to sustainability and reduce carbon footprint of medicines and healthcare.

Presentations:

A practical guide: Using the Atlas of Healthcare Variation to identify variation in opioid medicines dispensing in your local area Mr Myu Arumuganathan, Data Reporting Strategy Manager, Healthcare Variation, ACSQHC
Opioid analgesic stewardship in Acute Pain Clinical Care Standard Mr Steve Waller, Senior Project Officer, Medication without harm, ACSQHC
Perioperative opioid stewardship programs and post-surgical discharge opioid prescribing Dr Megan Allen, Anaesthetist, Royal Melbourne Hospital and The University of Melbourne
Opioid type and persistent postoperative opioid use Mr Evan Michell, St Vincent’s Clinical School, UNSW Medicine
Evidence based clinical practice guidelines for deprescribing opioids Dr Aili Langford, Research Fellow, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University
Pre-transplant opioid use and lung transplant outcomes Dr Christian Haron, The School of Medicine Sydney, The University of Notre Dame Australia and St. Vincent’s Hospital, Sydney

Session 3

Carbon footprint of medicines – improving sustainability across the medicine lifecycle for better health

What can be done to reduce carbon footprint of medicines and minimise pharmaceutical waste?

Most people might not guess but pills (or creams, patches, and inhalers, for that matter) have a big impact on the environment. Within our health care system, medicines are one of the largest line-item contributor to greenhouse gas emissions. In addition, pharmaceutical waste throughout the global supply chain can lead to environmental, human and animal toxicities, and in the case of antibiotic residues, to antimicrobial resistance (aka “superbugs”).

Many of these medicines are lifesaving, offering us enormous benefits and healthier lives when taken correctly. But with some thought, there may be a few things we can do to reduce their carbon footprint and minimise pharmaceutical waste, while keeping good health front and centre.

This session will focus on greener pharmaceuticals and practical ways to reducing carbon footprint across the medicine lifecycle (from manufacturing to waste disposal) while maintaining appropriate care.

Keynote Speakers:

Sustainability in medicines as a global priority

Associate Professor Alpana Mair, Head of Effective Prescribing and Therapeutics, Scottish Government and Senior Consultant, WHO

Our population is aging, but did you know that multi-morbidity and polypharmacy are more common as we get older? Dr Alpana Mair discusses medicine sustainability, with a focus on the safety and environmental burden of polypharmacy. In Europe, 8.6 million hospital admissions each year are due to adverse drug reactions. The majority of preventable admissions are seen in people aged over 65 years who are taking at least 5 medicines. Dr Mair explores medicine safety at different points in the patient pathway and introduces tools and resources developed by NHS Scotland to address medicine safety, polypharmacy, inappropriate prescribing and sustainability.

The carbon footprint of pharmaceuticals: Why is QUM so important?

Dr Forbes McGain, Anaesthetist and Intensive Care Physician, Western Health, Melbourne and Associate Professor, Sustainable Healthcare, University of Melbourne

Did you know that inhalers may have a larger carbon footprint than food waste? Dr Forbes McGain discusses the carbon footprint of anaesthetic gases, labour analgesics and respiratory inhalers, and highlights the importance of quality use of medicines from an individual, financial, societal and environmental perspective. Dr McGain describes the concept of cradle-to-gate greenhouse gas emissions for pharmaceuticals and showcases his work around the lifecycle assessment of morphine – from opium poppy farming in Tasmania through to packaging.

Climate-conscious care of respiratory diseases

Dr Valeria Stoynova and Dr Celia Culley, CASCADES, Centre for Sustainable Health Systems

What is the single greatest threat to human health in the 21st century? Dr Valeria Stoynova and Dr Celia Culley discuss the environmental impact of inhaler therapy and showcase climate-conscious patient education and prescribing tools. They take a stepwise look at the Climate Conscious Inhaler Prescribing Sustainability Pathway, discuss key data illustrating inappropriate inhaler prescribing, and introduce Choosing Wisely Canada’s recommendations on respiratory medicines. When thinking sustainably, health professionals need to consider inhaler type, inhaler technique, and whether there is an alternative inhaler with a lower carbon footprint.

Panel Discussion: What can be done to reduce carbon footprint of medicines and minimise pharmaceutical waste?

Dr Eugenie Kayak, Doctors for the Environment Australia

Ms Grace Wong, Pharmacists for the Environment Australia

The panel discussion will focus on the carbon footprint of medicines from manufacturing to waste disposal. Panellists will discuss medicine manufacturing process and the impact on the environment and note how health services can ensure that pharmaceutical manufacturers and suppliers improve their sustainability commitments. The panel will note the low level of awareness among health care practitioners regarding the carbon footprint of medicines being prescribed in practice. Attendees will hear about the importance of measuring carbon footprint of medicines and the environmental impact of medicines and the opportunities that this exercise can provide to identify potential carbon hotspots that could be addressed. The panel will discuss the issue of pharmaceutical waste and will highlight practical ways to recycling and reducing waste at an individual patient or health practitioner level and collectively at a national level, using blister packaging of medicines as an example. The panel will emphasize policies and strategies that are currently in place or being developed that will drive quality and sustainable use of medicines and health system sustainability as a whole.

Interactive Q&A Session: Environmental Sustainability and Climate Resilience Healthcare Module in development

Ms Tegan Taylor, Journalist and Broadcaster

Mr James Katte, Manager Sustainable Healthcare, National Standards, ACSQHC

Session 4

Thinking differently – innovative approaches to drive sustainable and quality use of medicines

Sustainability is a global challenge, that can only be overcome by taking responsibility and joining forces. Given the multifactorial causes of pharmaceutical waste, no single intervention is sufficient to overcome the problem and thus a multitude of approaches is needed.

Multiple stakeholders of the pharmaceutical chain at various stages of the medicine lifecycle including manufacturing, supply, prescribing, dispensing and use of medicines can contribute to minimising pharmaceutical waste. Digital health technologies can also promote the appropriate use of medicines and contribute to sustainability. Consumer awareness needs to be increased around preventative and lifestyle interventions, safe and quality use of medicines and strategies and approaches to pharmaceutical waste minimization and waste disposal interventions.

This session will explore technologies and innovative approaches to drive positive change towards sustainable and quality use of medicines.

Keynote Speakers:

What can consumers do to support environmental sustainability of health care?

Ms Darlene Cox, Executive Director, Health Care Consumers’ Association

How many tonnes of plastic and aluminium can be recovered from 2.7 million recycled blister packs? Ms Darlene Cox discusses the environmental sustainability of health care from a consumer perspective, and identifies actions that can be taken today to reduce the carbon footprint of medicines and health care. Ms Cox talks through examples of different blister pack recycling programs, Choosing Wisely Australia recommendations, and the Commission’s Sustainability Healthcare Module. Green and blue space interventions as alternatives to medicines are also discussed.

How digital health technologies promote the appropriate use of medicines and contribute to sustainability

Dr Paul Miles, Director eHealth and Medication Safety, ACSQHC

How can digital technology support medication safety and sustainability? Dr Paul Miles highlights the current array of digital health solutions, and discusses the benefits, challenges, drivers and opportunities for digitally enabled care. Digitally enabled systems for procurement, inventory management, and reporting for quality improvement can lead to more efficient medicine storage, more appropriate use of medicines, and a reduction in low-value prescribing and waste. Dr Miles also introduces the Commission’s digital health resources, including electronic medication management systems, real-time prescription monitoring, electronic prescribing (e-scripts), My Health Record and electronic medication charts.

Quality Use of Medicines – sustainable systems

Professor Faye McMillan AM, Community Pharmacist, Deputy National Rural Health Commissioner, Professor in Indigenous Health, UTS

Did you know that the Office of the National Rural Health Commissioner aims to improve the quality and sustainability of access to health services and health professionals in regional, rural, and remote Australia? Professor Faye McMillan explains the focus of the Office, and discusses the value of health workforces that represent the communities they serve. Professor McMillan talks about the Federation of International Pharmacists and Leaders in Indigenous Pharmacy Profession Education Network, and discusses standards to ensure quality training for pharmacists wanting to expand their scope of practice.

Panel Discussion: Projects and case studies that could be opportunities to scale

Dr Emma-Leigh Synnott, Medical Advisor, Sustainable Development Unit, Western Australia Department of Health

Ms Toni Riley, Pharmacist – RUM Project

Professor Branwen Morgan, Minimising Antimicrobial Resistance Mission (AMR) Lead at CSIRO

The panel will discuss innovative approaches to drive positive change towards sustainable and quality use of medicines. Panellists will discuss the use of non-pharmacological approaches to reducing the use of medicines and improve patient outcomes, including preventative and lifestyle interventions and social prescribing. Attendees will hear about the Return Unwanted Medicines (RUM) project and the need for raising awareness and driving uptake of the RUM program. The panel will highlight green procurement, manufacturing and supply chains, particularly in the context of antimicrobials and single use plastics. Attendees will hear about innovative technologies with great opportunities for scale up, to support quality and sustainable use of antimicrobials. Panellists will discuss approaches to handling pharmaceutical waste disposal, including antimicrobial waste. The panel will emphasize the need for embedding messaging in health policy and supporting collective action to drive positive change for our people and our planet.

Interactive Q&A Session: Sustainable prescribing in general practice

Ms Tegan Taylor, Journalist and Broadcaster

Dr Lee Fong, General Practitioner, Hunter New England and Medical Advisor, ACSQHC

Closing Address

Professor Villis Marshall AC, Chair of the Board of the ACSQHC

Close with Master of Ceremonies

Ms Tegan Taylor, Journalist and Broadcaster

More information

Contact NMS@safetyandquality.gov.au

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Quality Use of Medicines
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