NEWS & OPINION 40 EWAP MARCH 2024 to challenge this type of mentality and instead dig further for the root cause behind the policy in question. 4. Collaboration with administration: After identifying a potential area for improvement, share the data, observations, and concerns that have emerged from these interactions. Work together to develop ideas and suggestions on how to reach those goals without compromising patient care. 5. Persistence and enactment: Physicians, alongside administrators, nurses, and pharmacists, should work to finalize these proposed changes. It sometimes takes persistence and creativity to overcome the inevitable roadblocks. By substituting eminence - based attitudes with evidence-based data, physicians have incredible power to challenge assumptions, address concerns, and foster a culture of continuous improvement for the benefit of our patients. Drug waste and sustainability are important topics that impact us as physicians. As patient advocates, we have the capacity to drive transformative change within our institutions and ORs. Our duty is to enhance patient care while also contributing to a more sustainable healthcare ecosystem valuing efficiency, responsibility, and innovation. EWAP References 1. Palmer DJ, et al. Reducing topical drug waste in ophthalmic surgery: multisociety position paper. J Cataract Refract Surg. 2022;48:1073–1077. 2. Tauber J, et al. Quantification of the cost and potential environmental effects of unused pharmaceutical products in cataract surgery. JAMA Ophthalmol. 2019;137:1156 –1163. 3. Berkowitz ST, et al. Potential cost savings associated with a multiuse preoperative and preinjection eyedrop protocol. Ophthalmology. 2022;129:1305 –1312. 4. Sherry B, et al. How ophthalmologists can decarbonize eye care: A review of existing sustainability strategies and steps ophthalmologists can take. Ophthalmology. 2023;130:702 – 714. Editors’ note: Dr. Grodsky is Vitreoretinal Surgery Fellow at Ochsner Health, New Orleans, Louisiana. Dr. Palmer is Clinical Associate Professor at the Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. A lot of practices in the medical field do not have a scientific basis or evidence but have been carried forward as a general consensus or because the practice was being followed in the place of training. Use of perioperative drops also follow the same pattern. In many of the institutions there is a lot of drug waste especially dilating drops, antibiotic drops, and NSAIDs as they are only used preoperatively and discarded. There are several ways to avoid drug waste: • Observe practices carefully and critically and check if they are evidence based. • Many drugs which have been used preoperatively like antibiotic, NSAIDs can also be continued in the post operative period safely. • Multidose dilating drops can be used preoperatively for several patients on the same day with certain careful practice of keeping the nozzle sterile and ensuring there is no contact with skin or conjunctival mucosa. • Some of the drops are available as single UNIMS and can be used pre-operatively to reduced waste of multidose vials. • In the some of the institutions, sterile wicks of PVA soaked with medication can be used to obtain rapid dilatation pre-operatively. Dilating drops, Antibiotic drops and NSAIDs drops are opened and emptied into a sterile bowl containing sterile PVA wicks. These wicks are placed in the lower Fornix of the eye to be operated. This allows for good drug penetration and rapid dilatation and reduces drug waste. Such practices can easily be adopted in ambulatory surgery centres and would make pre-operative preparation more efficient and reduce unnecessary drug waste. • Sustainability and reducing waste should be the responsibility of every physician and association. Good practices that are efficient, improve sustainability with proper patient safety should be advocated by physician association. Associations should create platforms during conferences for healthy debate regarding current practices and newer innovative techniques to improve sustainability and reduce drug waste. • Physician association should also put forward safe and sustainable practices which are environmentally friendly to governmental organisations so that existing laws and programs can be modified. Drug Waste and sustainability are very important topics that impact us as physicians, our practices, and, hugely, the environment. As responsible physicians our duty is towards patients’ safety while at the same time ensuring sustainability. This needs a multipronged approach and consensus among all the stakeholders including drug manufacturers, Governmental agencies, physicians, their associations and nursing staff. Editors’ note: Dr. Sri Ganesh disclosed no relevant financial interests. Sri Ganesh, MD Nethradama Super Specialty Eye Hospital 256/14, Kanakpura main road, 7th Block main road, Jayanagar, Bangalore – 560070 chairman@nethradhama.org ASIA-PACIFIC PERSPECTIVES
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