Research improves the practice of environmentally sustainable actions in the medication process in hospitals

By Patricia de Oliveira Furukawa, Federal University of São Paulo, São Paulo, Brazil

Researchers from the Studies and Research Group in Health Services Administration and Nursing Management from The Federal University of Sao Paulo (UNIFESP) have developed studies to improve the practice of sustainable actions from an environmental point of view in hospitals. A recent doctoral thesis study carried out by researcher of the UNIFESP and member of the group, analyzed the sustainable actions taken by the nursing staff of an Intensive Care Unit (ICU) during the medication process and proposed interventions to improve environmental sustainability in a large hospital located in São Paulo – Brazil. The article was published in full in the journal Acta Paulista de Enfermagem.

This is a before and after study. For the research, the Lean Six Sigma process analysis methodology was applied. Originated in this industry, and currently being implemented by companies, including hospitals, that are seeking better results in terms of productivity and the quality of their products or services. Data were collected regarding the physical structure of the ICU, the practice of nursing on the sustainable actions of 648 medication processes (324 before and 324 after) and the amount of waste generated in the unit. The data was collected via observation routes and analyzed quantitatively. After the analysis of the data obtained in the pre-intervention stage, the following Lean Six Sigma tools were used in order to prioritize the problems to be solved. From this analysis, an action plan was developed outlining the improvements to be implemented, based on the causes/roots of the problems identified by the team. After the interventions, the data was analyzed again.

The analysis of medication processes revealed problems related to the physical structure, equipment, materials, methods, work environment and personnel, that weakened proper sustainable actions by the nursing team. The proposed interventions primarily involved the installation of efficient technologies to save on natural resources such as water, investment in suitable containers, changes in work methods to reduce materials and facilitate recycling and appropriate waste treatment, changes in institutional policies and training of the team. As a result, there was a reduction in the use of materials, such as plastic bags (37.1%), reduction in leftover hormonal anti-inflammatory drugs (67.1%), increased removal of labels from plastic bags to be recycled (146.9 %), and improvement in proper waste disposal (32.2%), especially those related to primary packaging for medications considered hazardous to the environment and human health, with a statistically significant difference of p-value <0.05. The reuse of plastic bags, although the percentage increased (42.9%), was not statistically significant (p-value = 0.417). In general, there was a major decrease in total waste generation (38.6%), due to reductions in materials used and infectious waste, sharps and normal non-recyclable waste. Based on the data, it is estimated that there was a reduction of 5,324.9 kilos in one month, in just the ICU.

Considering that there is currently a major concern for the scarcity of natural resources and the lives of all living beings due to the environmental impact caused by human actions, this study contributes to a necessary, ongoing search for best sustainability practices in hospital care. Furthermore, as hospitals strive to control costs, it is important to bear in mind that promoting sustainability practices yields not only environmental benefits, but also economic ones for the institution. The study was funded by CAPES (Coordination for the Improvement of Higher Education Personnel).

To read the article, visit:

FURUKAWA, P.O., et al. Environmental sustainability in medication processes performed in hospital nursing care. Acta paul. enferm. [online]. 2016, vol. 29, n.3, pp.316-324. [viewed 06 October 2016]. DOI: Available from:

External link

Acta Paulista de Enfermagem – APE: <>


Como citar este post [ISO 690/2010]:

FURUKAWA, P.O. Research improves the practice of environmentally sustainable actions in the medication process in hospitals [online]. SciELO in Perspective | Press Releases, 2016 [viewed ]. Available from:


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