Improving clinician adherence to the ‘green inhaler’ initiative: An audit of current practice

<bold>Introduction</bold> Pressurised metered dose inhalers (pMDI) contribute 3% to the carbon footprint of the UK National Health Service (NHS). Due to the detrimental environmental impact of pMDIs there are national and local initiatives to replace pMDIs with greener inhalers, namely Dry Powder Inhalers (DPI). Within our large NHS trust we have a green initiative policy targeting the reduction in pMDI prescribing through education and raised awareness within secondary care. <bold>Methods</bold> We conducted an audit across two hospital sites over a 1-month period, recording details of patients prescribed inhalers on admission, and if prescribed a pMDI on admission, whether an alternative greener inhaler was recommended by the physician or pharmacist. <bold>Results</bold> Of 157 patients identified in the audit, 81 (52%) patients were on a pMDI that had a DPI equivalent. 4 patients (4.9%) were offered a DPI equivalent. Discussion with junior doctors at an educational forum indicated a hesitance to change inhalers initiated in primary care, despite knowledge of carbon footprint impact of pMDIs. <bold>Conclusion</bold> The results suggest that raising awareness in secondary care alone may not solve the issue and that a more active intervention is needed to improve confidence amongst junior doctors when assessing inhalers in secondary care settings. Equally intervention at a primary care level, where most inhalers are prescribed, will be needed and could potentially be achieved through integrated respiratory care. Further research into outcomes of training clinicians to select appropriate inhalers will aid future interventions.