Latest News

Latest News

Call for applications: CSHP Foundation Board Industry Trustee

June 4, 2024

 

Call for applications
The Board of the CSHP Foundation is seeking applications for an
Industry Trustee

Selection Criteria:

  • Employed by either a research-based or generic pharmaceutical company.
  • A CSHP Member or employed by a CSHP Corporate member.
  • Demonstrated interest in hospital pharmacy practice and supporting the initiatives of the Foundation, its Mission and Vision.
  • Demonstrated employer support for the commitment required to fill the Trustee role.
  • No conflict of interest with the work of the Foundation.
     

Industry Trustee Term: 3 years (option to renew once, 6 years total).
Term of appointment will start November 1, 2024.

CSHP Foundation Industry Trustees are voting members of the Foundation Board. This is your opportunity to become directly involved in the work of the CSHP Foundation.
 
Are you interested? Information on CSHP Foundation Board Member responsibilities and application forms are available on the Foundation’s website at  https://cshp-scph.ca/foundation-board-member-recruitment

For additional information on position responsibilities and commitments, contact Michael LeBlanc, Chair, CSHP Foundation Board Trustees, at michael.leblanc@horizonnb.ca.

Completed application forms and other required documents should be submitted electronically to Rosemary Pantalone at rpantalone@cshp.ca.

Deadline Date for Applications is September 12, 2024
June 04, 2024
Call for applications: CSHP Foundation Board Industry Trustee

Latest News

Advocacy in Action: May 7

May 7, 2024
 
  

What's happened

May 15, Choosing Wisely Canada Climate Conscious Recommendations 

Professional Practice Specialist, Kiet-Nghi Cao, presented CSHP and CPhA’s joint hospital pharmacy recommendations to the hundreds in attendance on May 15’s Choosing Wisely Talks. 
 
The presentation of our ten new recommendations was part of Choosing Wisely Canada’s 40 new recommendations focused on sustainability. These recommendations were developed by national societies or associations spanning 20 specialties. Their goal is to provide practical ways to stop or reduce routine practices harming the environment without compromising patient care. 
 
To check out a recording of the presentation, click here.

May 15, Multi-Stakeholder Steering Committee on Drug Shortages 

CPO, Rita Dhami, participated in the Multi-Stakeholder Steering Committee on Drug Shortages to help work towards a more rigorous, coordinated approach to handling shortages. Health Canada provided an update on work being done as they evolve into the new Drug Shortages Directorate. The engaging drug shortage sessions at PPC and the Harrison Management Seminar were a topic of discussion. Health Canada expressed their appreciation for the opportunity to participate at Harrison. 

Ongoing, Health Canada Drug Shortages Meetings

CSHP is continuing to monitor these ongoing drug shortages:
  • May 7, Tier Assignment Committee: Shortages of Bupivacaine and epinephrine
  • May 17, Tier Assignment Committee: Thyrogen (Thyrotropin Alfa, 0.9 mg/vial) 

What's happening

May to June, NAPRA Consultation on Modernization of Drug Schedules

CSHP was part of an expert panel contributing to the modernization of the NAPRA Drug Schedules. After initial discussions with expert groups, NAPRA has outlined two potential models for non-prescription drug (NPD) scheduling, along with their respective terms of sale, for potential inclusion in the updated program. Moving forward, CSHP will be asking all members to contribute to formulating a response to these proposals.

June 6, Transforming Primary Care in Canada Summit

CSHP CEO Jody Ciufo and CPO Rita Dhami will be meeting with pharmacy leaders from across Canada- along with other prominent healthcare professionals, policymakers, and patient advocacy groups- at CPhA’s inaugural national summit. 

The Transforming Primary Care in Canada Summit aims to achieve consensus on the future roles of pharmacists and pharmacy teams in primary care. It will identify barriers and facilitators for integrating community pharmacies into primary care and outline priority areas for actionable initiatives. 

What's worth repeating

April 19-21, Bilateral Meetings with Officers  

CSHP's executive team, comprising President Ashley Walus, President Elect Katie Hollis, Past President Sean Spina, and Treasurer Megan Riordon, together with CEO Jody Ciufo and CPO Rita Dhami, engaged in discussions with these organizations to explore further collaboration: 

  • Indigenous Pharmacy Professionals of Canada: Jaris Swidrovich and Cassandra McClelland 
  • Canadian Association of Pharmacy Students and Interns: Madison Wong 
  • Association des pharmaciens des établissements de santé du Québec: Julie Racicot, Linda Vaillant, and Suzanne Atkinson 
  • American Society of Health-System Pharmacists: Nishaminy Kasbekar 
  • Board of Pharmacy Specialties: Sejal Lewis  
  • Pharmacy Examining Board of Canada: John Pugsley, Terri Schindel, and Harriet Davies 



To catch up on CSHP advocacy news, click here.

Have a question about Advocacy in Action or CSHP's advocacy and consultation work?
Reach out to our professional practice team!   

May 21, 2024
Advocacy in Action: May 21

Latest News

PPC 2024: A spectacular return 

May 21, 2024
 
 

By the numbers 

  • 482 Attendees 
  • 29 Sponsors 
  • 58 Exhibitors 
  • 1,635 Game codes redeemed 
  • $2,400 in Prizes 
  • 31 Educational sessions delivered 
  • 64 Posters presented 
  • 16 CEUs available

CCCEP Accreditation for PPC 2024 has ended, but there is still plenty to learn!
Head to the conference portal to catch up on sessions you may have missed or rewatch your favourite sessions. 

 

Access portal


Professional Practice Conference 2024 wrap-up

 
After three years of being combined with the Banff and Harrison Seminars, the Professional Practice Conference made its triumphant return as a standalone event, taking place both in-person in Niagara Falls, ON, and virtually worldwide. Attendees of this hybrid conference experienced leading educational sessions and social aspects of the event.
 

This year’s educational offerings were kicked off with an immersive pre-conference workshop led by Indigenous Pharmacy Professionals of Canada’s Amy Lamb and Cassandra McLelland alongside Elder Blu Waters, teaching those in attendance how to best frame health and wellness values of diverse Indigenous Peoples.
 
    
 

Then, at the opening ceremonies, Nkem Iroh welcomed CSHP delegates with an official introduction to the Black Pharmacy Professionals of Canada and helped to welcome International Keynote speaker Dr. John Clark to the stage.

  

Additional sessions encompassed a diverse range of topics, spanning from mRNA editing and climate-conscious pharmacy practice, to antibiotic-resistant infections in Canada or technologies for sterile compounding in addition to the Vision for Hospital Pharmacy Panel which empowered the driving forces of change, future roles, and best practices in pharmacy.


Plus, attendees took in six keynote speeches including Dr. Muhammad Mamdani’s speech on “Practical Applications of Artificial Intelligence in Healthcare" and Mark Black’s moving talk providing us with a look “Through a Patient’s Eyes” that perfectly closed out the conference. 

    

Meanwhile, PPC 2024 was also an excellent opportunity to reconnect with friends both familiar and new. Friday gave guests the chance to visit industry partners to learn more about their latest innovation, hospital partners to discuss career opportunities or head to the booths of our non-profit partners to learn more about their organizations! Later that evening, everyone was invited to have a roarin’ good time at the Hospitality at the Hard Rock where there were drinks, light snacks, spectacular surroundings, good music, and even better people. 

    

Saturday held a multitude of can’t miss events including the Gen Next: Student and Resident Networking Event, the Gala Dinner with Duelling Pianos Niagara closing out the evening with everyone out on the dance floor.  

Then, on Sunday morning, delegates were invited to relax and recharge for the conference’s final day with Rise ‘N Shine Yoga. This was not to forget the awesome prizes available to both in-person and virtual attendees, including gift cards, complimentary registration for next year’s Professional Practice Conference, and an abundance of swag. 

As we officially wrap up this year’s Professional Practice Conference, we’re already looking forward to next year when we’ll be welcoming you to the Nation’s Capital for the 56th edition of PPC! 

 
May 21, 2024
PPC 2024: A spectacular return

Latest News

Resource Spotlight: Green Practices in Hospital Pharmacy

May 7, 2024
Written by Huy Pham
 
This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca

Background

There are numerous environmental impacts from the use of pharmaceuticals throughout their life cycles. These can manifest from the greenhouse emissions associated with pharmaceuticals, from the ecological effects of pharmaceuticals in the environment, or from the impact of plastic waste from pharmaceutical packaging. However, there are green procurement strategies that can be implemented to reduce the environmental impact of the Canadian drug supply chain.

This “Resource Spotlight” contains links to tools and resources to help pharmacists learn more about environmental sustainability and green procurement and to aid in the implementation of sustainability initiatives, as well as provide examples of green initiatives that have been implemented. To learn more about the environmental impact of pharmaceuticals and sustainable procurement of pharmaceuticals, check out CSHP’s recent Clinical Pearls article on green supply chains in hospital pharmacy.

 

Canadian Resorces

Creating A Sustainable Canadian Health System In A Climate Crisis (CASCADES)
CASCADES is a pan-Canadian coalition that is dedicated to support the transition of the Canadian healthcare community system towards environmental sustainability and climate resilience. Their website contains a step-by-step guide to creating a practice of pharmacy that is climate resilient and low carbon sustainable. The CSHP Sustainability Task Force was involved with the review of the playbook. In addition, CASCADES has a playbook that aims to address the issue of environmental sustainability in organizational readiness, with an activity matrix to help identify opportunities for the implementation of sustainability.

Choosing Wisely Canada
The recommendations by Choosing Wisely Canada can reduce the amount of unnecessary treatments, which not only prevent undue harm to the patient as a result of unnecessary treatments but also reduces overall production of waste. There are recommendations drafted by CSHP specific to the hospital pharmacy setting as well as patient resources to enable conversations about their medications. In addition, Choosing Wisely had a webinar on the environmental co-benefits of reducing overuse and low-value care.

Plus, on May 15, CSHP will be joining Choosing Wisely Canada's talks to introduce CSHP and CPhA's brand new joint recommendations, offering practical ways to stop or reduce routine pharmacy practices that harm the environment without compromising patient care alongside the likes of Dr. Srinivas Murthy and Dr. Marko Balan from the Canadian Critical Care Society and many more. You can learn more about this event here and register here

Canadian Association of Pharmacy for the Environment (CAPhE)
CAPhE is a volunteer-run organization of pharmacy professionals who aims to improve and promote planetary health in the pharmacy profession. Their “Planetary Health & Pharmacy” webpage outlines topics such as pharmacy's contribution to pollution, disaster planning, and medication management during heat waves. They have a dedicated QID community for the exchange of best practices for climate change management and for encouraging the creation of committees to address environmental issues.

Canadian Coalition for Green Health Care
Canadian Coalition for Green Health Care is a green health care resource network that strives to create a net zero, climate resilient, environmentally sustainable health system by enabling the development of green policies and practices in healthcare. They have a free monthly Green Health Care Digest that outlines initiatives in green health care, upcoming events, and updates on Coalition activities. There is also an Environmental Stewardship Guidebook for hospitals that serves as a primer to facilitate the transition towards an overall greener structure. The Coalition, in partnership with the Children’s Hospital of Eastern Ontario (CHEO), drafted a Green Hospital Procurement Guide to aid health care institutions and organizations with implementing policies and procedures on environmentally preferable purchasing. A webinar hosted by Canadian Coalition for Green Health Care, PEACH Health Ontario, and CASCADES covers the issue of pharmaceuticals in the environment, how they enter the environment, and their impacts on wildlife.

Partnerships for Environmental Action by Clinicians and Communities for Hospitals / Health care facilities (PEACH)
PEACH is an Ontario initiative for the engagement, encouragement, and empowerment of individuals in the health care sector to create climate action at their facilities. The website acts as a hub for the information sharing on new initiatives and a platform for project collaboration. They have infographics and resources on topics including sustainable prescribing, the safe elimination of certain products and packaging, and creating a hospital green team.

Canadian Agency for Drugs and Technologies in Health (CADTH)
CADTH has published a Horizon Scanning report on the environmental impact of clinical care. The report outlines the principles and concepts behind environmentally sustainable health care and gives examples of initiatives and activities in sustainable clinical care such as inhaler prescribing and opportunities in procurement.

International Resources

Health Care Without Harm (HCWH)
HCWH is an international nongovernmental organization that works to reduce the environmental footprint of health care worldwide and lead a global movement for environmental health and justice. The U.S. and Canada branch has sample policies for hospitals to help facilitate environmental preferable purchasing. The website also has a dedicated page for waste management, describing strategies for waste management and the principles for sustainable health care waste management. 

Global Green and Healthy Hospitals (GGHH) 
GGHH is an international network of over 1,750 hospitals, health care facilities, health systems, and health organizations from more than 80 countries that strives to reduce the environmental impact of hospital care and promote environmental and public health. Their Sustainable Procurement Guide provides guidance on creating and advocating for sustainable purchasing strategies with examples of healthcare organizations worldwide.

National Health Service
The NHS has released a report on their ambitions towards net zero. This report outlines the specific interventions that the NHS has undertaken to reduce the carbon footprint of the NHS, as well as their proposition for new, sustainable models of care. The NHS has a monthly bulletin that provides updates on their efforts toward net zero and ways to be involved with the NHS's push towards sustainable care.

JanusInfo Pharmaceutical and Environment
JanusInfo is a Swedish drug information website developed by the Stockholm Region Pharmaceutical Committee. They have a database that classifies pharmaceuticals based on their environmental hazard and risk. Each drug in the database has a profile that describes their capacity for bioaccumulation, environmental persistence in aquatic environments, and toxicology to aquatic organisms. 

 
May 07, 2024
Resource Spotlight: Green Practices in Hospital Pharmacy

Clinical Pearls: Green supply chains in hospital pharmacy

April 23, 2024
By Huy Pham
 
This article is part of a series appearing in Interactions, our biweekly newsletter, written and researched by CSHP's students. We've created this series as a valuable learning activity for pharmacy students undertaking rotations at CSHP. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the students to select hot topics that are of interest and utility to both the students and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca.
 

Background

The Canadian drug supply chain can be conceptualized as having four phases: drug approval, manufacturing, procurement/distribution, and front-line delivery. The drug approval phase concerns the process of development of drugs by pharmaceutical companies and reviews of efficacy, safety, and quality performed by Health Canada to determine whether a drug product is approved for use in Canada. The manufacturing phase pertains to the mass production of pharmaceuticals and includes the process of acquiring the raw materials for the active pharmaceuticals, batch production, and surrounding Good Manufacturing Practices and quality control. The procurement/distribution phase of the drug supply chain describes the movement of pharmaceutical products from the manufacturers to the front-line users. Key players include the wholesalers and distributors, who are responsible for the warehousing and delivery of pharmaceutical products, and group purchasing organizations, who are the intermediaries for direct negotiation with manufacturers to secure cost savings. The front-line delivery phase refers to the end-user of the pharmaceutical products and includes hospitals, healthcare professionals, and patients.¹

Figure 1. Product flow of drugs to hospital pharmacies in Canada (adapted from Multi-Stakeholder Toolkit: A Toolkit for Improved Understanding and Transparency of Drug Shortage Response in Canada¹)

Environmental Impacts of Pharmaceuticals

There are many environmental impacts associated with the life cycle of pharmaceuticals and the drug supply chain, from the acquisition of raw materials to the disposal of drug products. These environmental impacts may broadly fall into these three categories: greenhouse gas emissions, pharmaceutical waste, and plastic waste.

Healthcare contributes 4.6% of Canada’s total greenhouse gas emissions and thus is a major contributor to climate change and its adverse impacts on health such as increased frequency of heat-related illness, exacerbations of asthma and chronic obstructive pulmonary disease due to exposure of wildfire smoke made more likely due to climate change, and worsening of mental disorders. The effects of climate change have both direct impacts on healthcare facilities and indirect impacts via effects on their supply chains, with the former contributing approximately 10% of total Canadian healthcare emissions and the latter the remaining 90% of the total emissions from healthcare in Canada. Pharmaceuticals, prescription and non-prescription drugs, contribute 25% of healthcare greenhouse gas emissions in Canada.²

Pharmaceuticals may appear in the natural environment through a variety of pathways. Pharmaceuticals excreted from the human body via urinary or fecal excretion pass through sewage treatment plants that are likely incapable of removing pharmaceuticals and its metabolites, effectively enabling their entry into natural waterways as part of the treated water and as part of the sewer sludge. Pharmaceuticals may also find entry into waterways when unused medications are improperly disposed. In addition, medications that are improperly disposed in solid waste may end up in landfills, where pharmaceutical residue can leach into the environment (soil, groundwater). Finally, the incineration of unused medications has the potential to release pollutants into the atmosphere.3

The presence of pharmaceuticals in the environment has numerous ecological impacts. Pharmaceuticals bioaccumulate up the food chain/web as predators consume organisms that are exposed to these pharmaceuticals. Humans may also be at risk through the consumption of organisms who have bioaccumulated pharmaceuticalse.4-6 Several studies have detected active pharmaceutical ingredients at concentrations that are known to cause acute and chronic toxicitiese.For instance, perch that were exposed to oxazepam in effluent-influenced surface waters exhibited alterations to their behaviour such as increased boldness, reduced sociality and increased feeding ratese.8,9 Another example includes vultures in South Asia who developed renal failure and gout due to exposure to diclofenac, causing the population to decline.10 The population decline of vultures had downstream effects. As scavengers, the vultures fed on uneaten carcasses that serve as breeding grounds for pathogenic bacteria and infectious diseases such as anthrax, which can posed a public health threat as these carcasses were in close proximity to human habitation. In addition, the decline in vultures enabled the growth of opportunistic species like feral dogs and rats, who are reservoirs of rabies and other zoonotic diseases. This resulted in the increased spread of rabies to humans.11,12 The overall decline in vulture populations and subsequence growth in dog and rat populations imposed an annual cost of over $1 billion cost to India.13 There is also a concern of increased antimicrobial resistance due to pharmaceuticals in the environment. A study of pharmaceutical pollution in the world's rivers found that over a quarter of the sampling sites had concentrations of ≥1 active pharmaceutical ingredient that exceeded what is considered safe for aquatic organisms or raised concern for antimicrobial resistance, with low- to middle-income countries being more likely to have these contaminated sites.14 Currently, there are no studies that observed a direct, acute impact of pharmaceuticals in the environment on human health.15-18 However, the possibility of harm from human exposure to pharmaceuticals in the environment cannot be ruled out as there are uncertainties relating to the effects of long-term exposure to pharmaceuticals in the environment through drinking water or the effects of simultaneous or sequential exposure to subtherapeutic concentrations of pharmaceuticals in the environment.17,19

Plastic waste from healthcare is also an environmental issue, where approximately 30% of all hospital waste is plastic.20 87% of all plastics in Canada, including healthcare plastics, ends up in landfills and the natural environment.21 Furthermore, 47% of plastic waste is from packaging.21 Plastics in the environment can cause physical harm to organisms through strangulation, starvation due to neck entanglement, and gastrointestinal obstruction due to ingestion of plastic debris.22 There is also ecological harm from the environmental leaching of the additives. For example, phthalate esters, which are widely used as plasticizers, can easily leach out of plastic products (specifically polyvinyl chloride products), where they can disrupt the endocrine and reproductive functions of organisms.23-25 Bisphenol A, another commonly used plasticizer, can interfere with the development and reproduction of aquatic animals and mammals.23-25 Exposure to these chemicals is associated with an increased risk of metabolic abnormalities like diabetes, reproductive dysfunctions, and breast cancer in humans.26,27

How Hospitals and Hospital Pharmacies Help Address the Environmental Impact of Pharmaceuticals

As one of the end-users of pharmaceuticals, hospitals, hospital pharmacists, and hospital pharmacy technicians  can play a major role in making the Canadian drug supply chain to become more environmentally sustainable. There is also growing interest in sustainable practices in the realm of Canadian healthcare, particularly with the formation of Creating A Sustainable Canadian Health System In A Climate Crisis (CASCADES) Canada with the aim of supporting a transition towards environmentally sustainable and resilient healthcare systems and the establishment of the Canadian Association of Pharmacy for the Environment (CAPhE) with a mission to promote planetary health in the pharmacy profession. In addition, CSHP has made environmental sustainability, one of its’ key priorities and has formed a sustainability task force in collaboration with CAPhE that will develop recommendations on how CSHP can move forward to integrate sustainability into hospital practice through advocacy and partnerships, education, sharing of research and quality improvement initiatives, and policy and procedure development.

One area that can be addressed is what specific medications are supplied to and used at the hospital. This is primarily based on what is listed in the hospital formulary, which is developed and approved by the Medical Advisory Committee (MAC) and the Pharmacy and Therapeutics (P&T) Committee. A drug is approved for use in a hospital based on a myriad of factors such as clinical efficacy of the drug, the financial impact of the hospital budget, and cost-effectiveness relative to available therapeutic alternatives. For the purposes of transitioning towards more environmentally friendly healthcare, the environmental impact of the drug can be included in the formulary submission and may serve as a criteria for evaluating the addition of the drugs to the formulary. The extent at which the active pharmaceutical ingredient(s) persist in the environment prior to degradation, the extent of bioaccumulation, and the ecological toxicity in particular could be points of consideration for determining if a drug may be added to the formulary. These would require discussions with the drug manufacturers and Health Canada to regulate this type of information pertaining to impacts on environment be included in their initial submission for drug approval.

A related area is the choice of suppliers from which the hospitals obtain their medications. Ideally, medications are being supplied from manufacturers that are intent on implementing green practices in the drug manufacturing process such as a transition to 100% renewable energy sources and waste minimization. This would involve discussions with the group purchasing organization, who can aid with identifying and prioritizing manufacturers implementing sustainability initiatives. Cooperation with group purchasing organizations may also help influence manufacturers towards sustainable practices through the leverage of collective purchasing power.

Hospitals may also address the environmental impact of pharmaceuticals (and by extension, hospital practice) through the establishment of a sustainability committee. This would ideally involve representatives from a variety of departments including representatives who are hospital pharmacists and pharmacy technicians. Sustainability committees could aid in facilitating change towards more sustainable practices including the green procurement of pharmaceuticals. They could also engage with suppliers and advocate for green proposals such as reducing the use of single-use plastic packaging for their products.

Hospital pharmacies can reduce the environmental impact of their operations by adopting green inventory management practices. For instance, the bulk purchase of drugs used at large quantities could aid in reducing emissions from transportation and waste from packaging. On the other hand, the purchase of smaller vial sizes could minimize the amount of waste from unused liquid medications. Regular monitoring of drug inventory may aid in reducing the amount of expired medications due to overstocking. A unit-dose medication distribution system could aid in reducing medication wastage compared to a traditional or ward stock system, with the additional benefit of reducing the error rate. Increasing the frequency for batch compounding of sterile products can also reduce the amount of unnecessary waste.28,29 For instance, a pediatric pharmacy's switch from a 1-batch-per-day to a 3-batch-per-day schedule reduced pharmaceutical waste by 31.3% from 28.7% to 19.7% with additional annual cost savings of $183,380.28 The reuse of supplies can also be useful in reducing waste. For example, metered-dose inhalers that are previously used with a patient-specific spacer can be reprocessed and reused after proper disinfection of the MDI canister, cap, and actuator with 70% isopropyl alcohol. The disinfection process may be performed by pharmacy technicians. These inhalers would have to assess for their remaining doses either by checking the dose counter or weighing the inhaler.30-32 This initiative would require cooperation with infection control departments to minimize cross-contamination and transmission of infections.

Individual hospital pharmacists may also consider environmental impact as part of their clinical decision-making for their pharmacotherapy care plan. For example, pharmacists can promote the use of dry powder inhalers or soft mist inhalers over metered-dose inhalers for asthma and chronic obstructive pulmonary disorder given that, unlike meter-dose inhalers dry powder inhalers and soft mist inhalers lack the use of hydrofluorocarbons, which are potent greenhouse gases. As a result, these inhalers have a smaller carbon footprint than metered-dose inhalers.33-35 This would ideally involve assessment of patients to determine if these inhalers are clinically appropriate as well as a discussion of patient preferences. Hospital pharmacists, through medication reviews, may also identify unnecessary drug therapies that can be deprescribed, thereby removing the environmental impacts associated with the follow-up monitoring and refill visits post-discharge.
 

References

  1. The Multi-Stakeholder Steering Committee on Drug Shortages in Canada. Multi-Stakeholder Toolkit: A Toolkit for Improved Understanding and Transparency of Drug Shortage Response in Canada [Internet]. Drug Shortages Canada. 2017 [cited 2023 Jun 30]. Available from: https://www.drugshortagescanada.ca/files/MSSC_Toolkit_2017.pdf
  2. Eckelman MJ, Sherman JD, MacNeill AJ. Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis. PLoS Med. 2018 Jul 31;15(7):e1002623.
  3. Thornber K, Adshead F, Balayannis A, Brazier R, Brown R, Comber S, et al. First, do no harm: time for a systems approach to address the problem of health-care-derived pharmaceutical pollution. Lancet Planet Health. 2022 Dec;6(12):e935–7.
  4. Anand U, Adelodun B, Cabreros C, Kumar P, Suresh S, Dey A, et al. Occurrence, transformation, bioaccumulation, risk and analysis of pharmaceutical and personal care products from wastewater: a review. Environ Chem Lett. 2022 Aug 17;20(6):3883–904.
  5. Muir D, Simmons D, Wang X, Peart T, Villella M, Miller J, et al. Bioaccumulation of pharmaceuticals and personal care product chemicals in fish exposed to wastewater effluent in an urban wetland. Sci Rep. 2017 Dec 5;7(1).
  6. Xie Z, Lu G, Yan Z, Liu J, Wang P, Wang Y. Bioaccumulation and trophic transfer of pharmaceuticals in food webs from a large freshwater lake. Environ Pollut. 2017 Mar;222:356–66.
  7. Brausch JM, Connors KA, Brooks BW, Rand GM. Human Pharmaceuticals in the Aquatic Environment: A Review of Recent Toxicological Studies and Considerations for Toxicity Testing. In: Whitacre D, editor. Reviews of Environmental Contamination and Toxicology. Springer Science & Business Media; 2012. p. 1–99.
  8. Brodin T, Fick J, Jonsson M, Klaminder J. Dilute Concentrations of a Psychiatric Drug Alter Behavior of Fish from Natural Populations. Science. 2013 Feb 14;339(6121):814–5.
  9. Brodin T, Nordling J, Lagesson A, Klaminder J, Hellström G, Christensen B, et al. Environmental relevant levels of a benzodiazepine (oxazepam) alters important behavioral traits in a common planktivorous fish, (Rutilus rutilus). J Toxicol Environ Health A. 2017 Aug 22;80(16–18):963–70.
  10. Oaks JL, Gilbert M, Virani MZ, Watson RT, Meteyer CU, Rideout BA, et al. Diclofenac residues as the cause of vulture population decline in Pakistan. Nature. 2004 Jan 28;427(6975):630–3.
  11. Ogada DL, Keesing F, Virani MZ. Dropping dead: causes and consequences of vulture population declines worldwide. Ann N Y Acad Sci. 2011 Dec 16;1249(1):57–71.
  12. Pain DJ, Cunningham AA, Donald PF, Duckworth JW, Houston DC, Katzner T, et al. Causes and Effects of Temporospatial Declines of Gyps Vultures in Asia. Conserv Biol. 2003 Jun;17(3):661–71.
  13. Markandya A, Taylor T, Longo A, Murty MN, Murty S, Dhavala K. Counting the cost of vulture decline—An appraisal of the human health and other benefits of vultures in India. Ecological Economics. 2008 Sep;67(2):194–204.
  14. Wilkinson JL, Boxall ABA, Kolpin DW, Leung KMY, Lai RWS, Galbán-Malagón C, et al. Pharmaceutical pollution of the world’s rivers. Proc Natl Acad Sci U S A. 2022 Feb 14;119(8).
  15. Bercu JP, Parke NJ, Fiori JM, Meyerhoff RD. Human health risk assessments for three neuropharmaceutical compounds in surface waters. Regul Toxicol Pharmacol. 2008 Apr;50(3):420–7.
  16. Dai C, Li S, Duan Y, Leong KH, Tu Y, Zhou L. Human health risk assessment of selected pharmaceuticals in the five major river basins, China. Sci Total Environ. 2021 Dec;801:149730
  17. Daughton CG. Pharmaceuticals as Environmental Pollutants: The Ramifications for Human Exposure. In: Heggenhougen HK (Kris), editor. International Encyclopedia of Public Health [Internet]. Elsevier; 2008 [cited 2023 Jul 6]. p. 66–102. Available from: http://dx.doi.org/10.1016/b978-012373960-5.00403-2
  18. Le Corre KS, Ort C, Kateley D, Allen B, Escher BI, Keller J. Consumption-based approach for assessing the contribution of hospitals towards the load of pharmaceutical residues in municipal wastewater. Environ Int. 2012 Sep;45:99–111.
  19. Jones OAH, Voulvoulis N, Lester JN. Potential Ecological and Human Health Risks Associated With the Presence of Pharmaceutically Active Compounds in the Aquatic Environment. Crit Rev Toxicol. 2004 Jan;34(4):335–50.
  20. Lee BK, Ellenbecker MJ, Moure-Eraso R. Analyses of the recycling potential of medical plastic wastes. Waste Manag. 2002 Aug;22(5):461–70.
  21. Environment and Climate Change Canada. Economic study of the Canadian plastic industry, markets and waste : summary report to Environment and Climate Change Canada [Internet]. Government of Canada. 2019 [cited 2023 Jun 21]. Available from: https://publications.gc.ca/collections/collection_2019/eccc/En4-366-1-2019-eng.pdf
  22. Li P, Wang X, Su M, Zou X, Duan L, Zhang H. Characteristics of Plastic Pollution in the Environment: A Review. Bull Environ Contam Toxicol. 2020 Mar 12;107(4):577–84.10.
  23. Mathieu-Denoncourt J, Wallace SJ, de Solla SR, Langlois VS. Plasticizer endocrine disruption: Highlighting developmental and reproductive effects in mammals and non-mammalian aquatic species. Gen Comp Endocrinol. 2015 Aug;219:74–88.
  24. Oehlmann J, Schulte-Oehlmann U, Kloas W, Jagnytsch O, Lutz I, Kusk KO, et al. A critical analysis of the biological impacts of plasticizers on wildlife. Philos Trans R Soc Lond B Biol Sci. 2009 Jul 27;364(1526):2047–62.
  25. Talsness CE, Andrade AJM, Kuriyama SN, Taylor JA, vom Saal FS. Components of plastic: experimental studies in animals and relevance for human health. Philos Trans R Soc Lond B Biol Sci. 2009 Jul 27;364(1526):2079–96.
  26. Giulivo M, Lopez de Alda M, Capri E, Barceló D. Human exposure to endocrine disrupting compounds: Their role in reproductive systems, metabolic syndrome and breast cancer. A review. Environ Res. 2016 Nov;151:251–64.
  27. North EJ, Halden RU. Plastics and environmental health: the road ahead. Rev Environ Health. 2013 Jan 1;28(1):1–8.
  28. Abbasi G, Gay E. Impact of Sterile Compounding Batch Frequency on Pharmaceutical Waste. Hosp Pharm. 2017 Jan;52(1):60–4.
  29. Toerper MF, Veltri MA, Hamrock E, Mollenkopf NL, Holt K, Levin S. Medication Waste Reduction in Pediatric Pharmacy Batch Processes. J Pediatr Pharmacol Ther. 2014 Jun 1;19(2):111–7.
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April 23, 2024
Clinical Pearls: Green supply chains in hospital pharmacy

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