Pharmaceutical waste reduction activities in pharmacies: a Delphi survey with pharmacy staff from Denmark and Iceland

Introduction: Reducing pharmaceutical waste is crucial for minimizing environmental harm and ensuring sustainable medication use. Despite its recognized importance, limited knowledge exists on which activities are both impactful and feasible in pharmacy practice.
Aims/Objectives: This study aimed to rank the impact and feasibility of various pharmaceutical waste reduction activities in pharmacies.
Methods: Scientific and grey literature searches were conducted to identify studies addressing pharmaceutical waste reduction activities in pharmacies. These activities formed the basis of a questionnaire used in a two-round online Delphi survey with pharmacy staff from Denmark and Iceland. Participants ranked the impact and feasibility of each activity on a scale from 1 (no impact at all, absolutely not feasible) to 4 (high impact, highly feasible or already implemented).
Results: The literature search revealed 30 studies on pharmaceutical waste management, drug reuse, or other sustainability activities in pharmacies. From these, 34 pharmaceutical waste reduction activities were identified, grouped into 10 categories, and included in the initial questionnaire. A total of 114 participants enrolled in the surveys: 82% were pharmacists, 12% were pharmacy technicians; 65% worked in community pharmacies, and 18% in hospital pharmacies. Additionally, 55% reported “often” considering sustainability in their workplace, while 33% thought about it “sometimes.” Three activities ranked 3 or above for both impact and feasibility: (1) “Ordering expensive and rarely used medicines to the pharmacy the day before the patient needs them” (mean impact: 3.9, mean feasibility: 3.5), (2) “Dose-dispensed medicines” (mean impact: 3.9, mean feasibility: 3.0), and (3) “Ensuring patients can finish medications before expiration” (mean impact: 3.5, mean feasibility: 3.0).
Discussion/Conclusion: The study identified key activities balancing high impact and feasibility in reducing pharmaceutical waste in pharmacies. The findings provide a foundation for prioritizing actionable strategies to minimize pharmaceutical waste while maintaining high quality of patient care.