Reduction of unnecessary repackaging as an environmental sustainability measure

The main objective is to describe the project and evaluate the impact of replacing repackaged medications with unit dose presentations in 15 public hospitals within a regional health system. Secondary objectives include identifying differences in the changes implemented across the 15 audited hospitals and conducting an exploratory analysis of the potential impact in other non-audited centers that requested participation in the project.

A database containing over 2,000 medications available in unit dose format was developed and is updated monthly. In parallel, an automated system based on decision-making algorithms was implemented to identify improvement opportunities in medication procurement. The system was adopted either individually by hospitals or through centralized structures at the regional or private level. The analysis included data from 15 public hospitals, where the reduction in repackaging and its environmental, economic, and operational impact were assessed by measuring material, time, and cost savings. The results were subsequently extrapolated to the 172 hospitals that applied.

In the 15 monitored hospitals, repackaging of approximately 1.27 million tablets per year was avoided, resulting in estimated savings of 17,016 km of packaging material, 866 kg in weight, and 113,693 min of labor. The avoided costs in materials and machinery amounted to 36,274€ annually. No statistically significant differences were observed in project adoption across the hospitals (p = 0.234). The extrapolation to 172 hospitals suggests a potential impact of 16.67 million tablets no longer requiring repackaging per year, with an estimated savings of 2220.13 km of material, 24,723 h of labor, and 451,768€ annually.

Replacing repackaged medications with commercially available unit dose formats significantly reduced material consumption, labor time, and repackaging-related costs in the evaluated hospitals. The implementation of the project was consistent across the 15 monitored hospitals. Furthermore, the model proved to be scalable. The main limitation identified was the limited availability of unit dose medications on the market; therefore, it is recommended to prioritize their inclusion in procurement processes and to promote their development by the pharmaceutical industry.