Eyeworld

DECEMBER 2023 | EYEWORLD | 17 Contact Grodsky: grodskylsu@gmail.com Palmer: dpalmermd@comcast.net dialogue should aim to uncover the reasons behind the current practices and shed light on any concerns that contribute to waste. This might involve revisiting guidelines for drug usage, storage, and disposal, or even inves- tigating and challenging state or national policies. If no such regulatory policy exists, the AAO Topical Medical Waste Reduction Act legislative template is a good starting point to initiate change. It's essential to approach these discussions with an open mind, seeking to understand issue complexities. 3. Challenging the status quo: A common eminence-based refrain of "That's just the way it is" can often hinder progress. Physicians should persistently question the status quo, asking why certain practices are in place and whether they align with best practices and sustainability goals. It takes courage to chal- lenge 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 sugges- tions on how to reach those goals without compromising patient care. 5. Persistence and enactment: Physicians, alongside administrators, nurses, and phar- macists, should work to finalize these pro- posed 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 assump- tions, 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 trans- formative change within our institutions and ORs. Our duty is to enhance patient care while also contributing to a more sustainable health- care ecosystem valuing efficiency, responsibility, and innovation. This is often achieved via administration of dif- ferent types of eye drops. Unfortunately, at some institutions and ASCs, these drops are used once and discarded, requiring a new bottle for the next patient. The cost of eye drop waste and related carbon emissions produced annually is astronomical, 2,3,4 especially at high-volume cen- ters. Patients may find repurchasing these same medications for continued postop care finan- cially and logistically challenging. As a result, we, like so many of our colleagues, advocate for and educate others on the recommendations of a multisociety position paper 1 calling for: 1) multidose eye drop use on multiple patients up to the manufacturer expiration date using CDC infection control guidelines, and 2) facilities to allow taking home partially used topical OR medications for postop use when indicated. We have learned that every institution or ASC is different and has differing rationales to support their policies regarding multiuse eye drops. These can include concerns about sterility and patient safety, government-man- dated programs like Section 340B, state laws prohibiting multidosing eye drops, or simply an unchallenged longstanding policy. Nevertheless, the non-alignment between manufacturer label- ing and actual practice underscores the need for a closer examination of existing protocols and addressing waste without compromising patient care. Here, we outline a proactive approach for physicians to drive change within their insti- tutions and ORs, emphasizing the importance of persistence, open dialogue, interaction with state eye and medical societies, and a commit- ment to sustainability. 1. Observation and analysis: When physi- cians observe daily practices with a keen eye toward sustainability, there are bound to be many identified situations where a positive change can be made, such as if eye drops are being used as single-use instead of multiuse and/or patients are not allowed to bring their partially used topical OR medications home. 2. Engage in constructive dialogue: Armed with observational insights, physicians should initiate conversations with colleagues, nursing staff, administrators, pharmacists, and state eye and medical societies to determine if facility policies are local or statewide. This 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. Quantifica- tion of the cost and potential environmental effects of unused pharmaceutical products in cat- aract 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 ophthal- mologists can decarbonize eye care: A review of existing sus- tainability strategies and steps ophthalmologists can take. Oph- thalmology. 2023;130:702–714.

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