2026 Eastern States Conference

Authors: Lillian Babbie, PharmD; Alem Mulat, PharmD, BCPS; Joanne Ondrush, MD; Candace Ly, PharmD, BCSCP; Millicent Deya, PharmD, MHA; Jonathan Meli, PharmD, MS
Learning Objective: Describe strategies pharmacists can employ to reduce intravenous pharmaceutical waste and subsequent carbon emissions in a community hospital setting.
Purpose: Expired medications contribute substantially to pharmaceutical waste, leading to both financial losses and environmental concerns. Few studies have examined how returns data can inform formulary management. This project evaluates whether a structured review of pharmaceutical returns, carbon emissions, and expiration data can reduce IV medication waste and optimize inventory management in a community hospital.
Methods: This prospective quality improvement study was conducted at UVA Prince William Medical Center following IRB approval. Baseline returns data were collected over a 6-month period (November 2024 through April 2025). A pharmacy workgroup, including clinical pharmacy specialists, a supply chain supervisor, and a clinical sustainability chair, then convened biweekly from January 2026 through May 2026 to review IV pharmaceutical returns data, focusing on non-creditable, high-expense, and expiratory-related medications. For each medication, usage trends, clinical necessity, published emission factors for pharmaceutical disposal, and cost were assessed. Interventions included formulary changes (removal or restriction), inventory adjustments (par-level changes), beyond-use-dating (BUD) changes, and staff education. The primary endpoint was reduction in IV pharmaceutical waste and carbon footprint emissions, measured as percent reduction of waste prevented during the intervention period compared to the equivalent dollar value of waste during the baseline period. Secondary endpoints included the proportion of reviewed medications requiring intervention and the type of interventions utilized.
Results: 59 IV medications were analyzed. Of the 59 medications reviewed, 29 had opportunity for at least one intervention. Opportunities included 7 BUD changes, 1 formulary change, 16 staff education sessions, 9 protocol changes, and 2 par level adjustments. Carbon footprint data (gCO2e) were calculated for 37 of 59 (62.7%) medications. Waste volume and carbon emission reductions were demonstrated across multiple high-cost IV medication categories following workgroup-directed interventions.
Conclusions: A structured biweekly pharmacy workgroup review of IV pharmaceutical returns data can identify actionable waste-reduction opportunities in a community hospital. Formulary modifications, education, and BUD changes represent scalable, pharmacist-led interventions to reduce pharmaceutical waste and environmental impact. Integrating carbon footprint calculations into formulary review positions pharmacy teams as active contributors to health-system sustainability goals.
Self-Assessment Question: What are some strategies that pharmacists in a hospital setting could employ to reduce IV pharmaceutical waste?