Nurses are at the center of all patient care and as a result are consistently at the patient bedside. Nurses influence patient care while also having an opportunity to influence the cost of care through efficient care. Though healthcare costs are influenced by a myriad of factors, inefficiencies in resource management and supply waste are changeable by nurses. Solid waste and greenhouse gas emissions were shown to be 5.5 kg and 45 kg CO2-e per hospitalization, respectively (Prasad, et al., 2021). In a neuro ICU, total daily unit waste was over 200 pounds averaging just under 11 pounds per patient (Corbin, et al., 2022). Plastics derived from fossil fuels are widely used in healthcare to make many of the supplies used by nurses and when disposed can increase microplastics in our air, water, and soils (See, 2023). The sheer number of health care facilities and their patients can lead to excessive waste given the total number of healthcare providers who may lack awareness and engagement in waste-reduction behaviors. Decreases in disposable waste could begin with hospitals serving to guide more ethically sound and sustainable initiatives thus leading to a reduction in overall waste-related environmental impact (Ghersin, et al., 2020). Reduction of waste going to landfills, unnecessary production of greenhouse gases, and reduction of microplastics in intensive care units (ICUs) among other areas of waste in healthcare, are influenced by healthcare providers. Nurses have an opportunity to lead the healthcare industry toward more sustainable practices and reductions in the healthcare environmental footprint.

Productive engagement of nurses in making the change to more sustainable practices can begin simply through increased awareness of wasteful practices (Morrow et al., 2013). Focused efforts in a specific area or waste stream can serve as a useful starting place. Waste streams include disposed waste, diverted waste, and avoided waste (Schenk, et al., 2023). Nurses are ideally positioned to avoid waste through their own efficient supply use and non-use along with their modeled actions and behaviors with other healthcare providers involved in patient care.

This evidence-based project addresses unnecessary waste in medical surgical ICUs by using bedside supply carts as opposed to general supply rooms. Excess supplies in a patient’s room are typically deemed contaminated, may be opened by accident and not needed, or left only to expire before use – avoidable waste (Wohlford, et al., 2020). Use of bedside supply carts located in patient’s rooms could greatly reduce waste through efficient use of supplies and reduced waste of unused yet contaminated supplies. Literature reviewed focused on managing waste in healthcare, specifically in medical-surgical ICUs, and locating sources of avoidable waste, such as single-use equipment, disposable packaging, and discarding unused supplies left in the patient’s room after leaving the unit. For example, Cockerham et al. (2016) found supply changes led to impressive 45% to 80% decrease in stocked supplies on two different ICU bedside carts. Additionally, nursing and supporting staff found the cart turnover process to be faster and easier allowing more time for patient-care related work (Cockerham, et al., 2016).

Standardized bedside supply carts are used to optimize resources and supplies, prevent overstocking, and reduce the disposal of supplies or packaging that are expired, contaminated, or unused. The goal of the practice change is to decrease nurse created waste at the bedside. Utilizing the implementation of standardized bedside supply carts to maximize sustainability and reduction of waste without compromising the highest quality of patient care. Findings noted in the literature indicate that unnecessary hospital waste in medical-surgical ICUs can be decreased substantially by implementing standardized bedside supply cart stocked with essential supplies needed that are easily accessible and remain organized to assist nurses in providing optimal patient care.

Evidence identified during this project focuses on waste reduction in healthcare by nurses and the utilization of standardized bedside supply carts. By advocating for standardized bedside supply carts for nurses’ use, rather than a centralized unit supply room, this will enhance supply efficiency and reduce waste in medical-surgical ICUs. This nurse-driven waste-reduction effort could spark a movement in identifying more sustainable practices in healthcare and creating new methods to be more responsible with resources. Ultimately, this nurse-led change could lead to more efficient and better patient care.

Brief biography for authors/contributors:

Ellee Edgar, Abigail Graves, Justin Tijerina, and Emma Wasson graduated on May 9th, 2024, with Bachelor of Science in Nursing degrees from the Fran and Earl Ziegler College of Nursing at the University of Oklahoma Health Sciences. They would like to thank Dr. Mark Fisher for his wonderful guidance and help throughout their nursing school journey. They will be starting their nursing careers in the ER, ICU, and PICU. They chose to research the reduction of waste in the ICU and the impact that nurses can have because they felt this was a growing issue in healthcare facilities today. Serving as the senior author is Mark. J. Fisher, Ph.D., RN, CNE, an Assistant Professor at the Fran and Earl Ziegler College of Nursing at the University of Oklahoma Health Sciences.

The poster was presented in March 2024 – presentation details: Graves, A., Wasson, E., Edgar, E., Tijerina, J. & Fisher, M.J. (2024). Nurse Driven Initiatives to Reduce Supply Waste Produced in the Intensive Care Unit. Partners in Quality conference. OU Health, Veterans Administration, Sigma Theta Tau International, and the Fran and Earl Ziegler College of Nursing OUHSC. Oklahoma City, Oklahoma. March 13, 2024.

References

Cockerham, M., Haverland, A., & Solvang, N. (2016). Battling Supply Waste in the ICU: A Bedside Cart Standardization Project. Journal of PeriAnesthesia Nursing, 31(1), 89–94. https://doi.org/10.1016/j.jopan.2015.11.003

Corbin, L., Hoff, H., Smith, A., Owens, C., Weisinger, K., & Philipsborn, R. (2022). A 24-Hour Waste Audit of the Neuro ICU during the COVID-19 Pandemic and Opportunities for Diversion. The journal of climate change and health, 8, 100154. https://doi.org/10.1016/j.joclim.2022.100154

Ghersin, Z. J., Flaherty, M. R., Yager, P., & Cummings, B. M. (2020). Going green: decreasing medical waste in a paediatric intensive care unit in the United States. The New Bioethics, 26(2), 98–110. https://doi.org/10.1080/20502877.2020.1767916

Morrow, J., Hunt, S., Rogan, V., Cowie, K., Kopacz, J., Keeler, C., & Kroh, M. B. B. and M. (2013). Reducing Waste in the Critical Care Setting. Nursing Leadership, 26 (Special Issue). https://www.longwoods.com/content/23362/nursing-leadership/reducing-waste-in-the-critical-care-setting

Prasad, P. A., Joshi, D., Lighter, J., Agins, J., Allen, R., Collins, M., Pena, F., Velletri, J., & Thiel, C. (2021). Environmental footprint of regular and intensive inpatient care in a large US hospital. The International Journal of Life Cycle Assessment, 27(1), 38–49. https://doi.org/10.1007/s11367-021-01998-8

‌Schenk, E. C., Johnson, S., Kelley-Gustafson, B., & Turley, O. (2023). Nursing Waste Reduction for a Healthy Environment. Journal of Radiology Nursing, 42(1), 57–61. https://doi.org/10.1016/j.jradnu.2022.12.008

See, K. C. (2023). Improving environmental sustainability of intensive care units: A mini-review. World Journal of Critical Care Medicine, 12(4), 217–225. https://doi.org/10.5492/wjccm.v12.i4.217

Wohlford, S., Esteves-Fuentes, N., & Carter, K. F. (2020). Reducing Waste in the Clinical Setting. AJN, American Journal of Nursing, 120(6), 48–55. https://doi.org/10.1097/01.naj.0000668744.36106.24