The Initial Problem and its Impact

As of March 2018, the Neonatal Intensive Care Unit at the John Radcliffe Hospital in Oxford was purchasing 96,000 polystyrene cups per year for use of staff and visitors, at a cost of £4,464. The environmental impact of these single use cups contributed to the 2.5 billion takeaway coffee cups that are thrown away each year in the United Kingdom.

Polystyrene is non-recyclable in most areas including Oxford, and is estimated to take a minimum of 500 years to decompose. Polystyrene and other single use plastics are contributing to litter and pollution particularly in waterways and oceans. The European Parliament recently voted to ban a wide range of single use plastics by 2021, including single use polystyrene cups and those made from plastics that degrade into tiny fragments (oxo-degradable plastics).

As paediatricians I feel that we in particular have a duty to consider what kind of environment we are shaping for children. Similarly, if we hope to continue improving the health and wellbeing of children, it is vital that we consider how to be more sustainable in our everyday lives, taking into account the inevitable financial and resources constraints that will apply in the future.

Causes of the Problem

Polystyrene cups were readily available near hot drink making facilities and water fountains on the neonatal unit, and these single use products were frequently used by both staff and parents. There was no educational material for staff or parents about the impact this has to the environment or encouragement or offerings of alternatives.

Project Aim Statement

The aim of this eco-QIP was to remove all polystyrene cups from the neonatal unit by August 2018. This would be supported with simultaneous introduction of a reusable and sustainable alternative with all proceeds benefiting the local neonatal charity. The over-riding aim was to educate parents and staff about the importance of reusable cups and to change cultures within the unit to support a more sustainable future.

Stakeholders

This project was designed and implemented by Dr Claire Roome, Paediatric trainee in the Thames Valley Deanery. The initial cost of purchasing the sustainable cups was kindly provided by the SSNAP (Support for the Sick Neonate and Their Parents) Charity. All proceeds from the sale of the bamboo cups went directly to them. The John Radcliffe Neonatal Unit saved nearly £5000 per year as the purchase of polystyrene cups was discontinued.

PDSA Cycles / Solution(s) Tested

• Plan

Aim to remove the polystyrene cups from the unit by August 2018. To consider and implement an alternative that would provide a sustainable and environmentally friendly choice. Consider methods to highlight and integrate sustainability into daily life on the neonatal unit.

• Do

1. A sustainable and reusable bamboo cup was designed with the Ecoffee cup company, and sold on-site and online with all proceeds going to the SSNAP charity.
2. In order to support mothers to be able to spend time with their babies at the cot-side, reusable cups were provided free of charge on the neonatal unit for each cot space. One cup was allocated per cot and the cups were not to leave the neonatal unit.
3. A poster campaign to highlight the issue with using single use polystyrene cups was implemented to encourage staff to bring their own reusable cup to work, and to promote the new bamboo alternatives. The poster was professionally made with the financial support and expertise of the Ecoffee cup media design department.
4. An environmental awareness day was planned to signify the removal of the polystyrene cups. This also hosted other sustainable initiatives such as a local reusable nappy scheme and the recycling team from Oxford City Council. The aim of this event was to engage staff and support a change in culture within the unit.
5. A plan was made to highlight the project and the environmental awareness day using local media outlets.

• Study

Change in attitudes to sustainability is a difficult outcome to quantify but attempts were made to try and reflect on how well the unit engaged with the project. This was done by reflecting upon the response to the environmental awareness day and considering the impact of media coverage of the event. Similarly, the adoption and staff reaction to the new sustainable system gives some insight into change in attitudes.

The environmental impact of the project was studied by reviewing the reduction in purchases of polystyrene cups once the project had been implemented. The financial benefits were easily calculated by considering the cost benefit of reduced polystyrene cup purchases. Similarly, the charitable funds raised as a result of bamboo cup sales can be considered.

• Act

Once the PDSA cycle was complete and the project result analysed, the findings were presented at the regional paediatric presentation day. The aim was to share findings amongst the region and to consider the limitations and possible ways to combat them.

Data Results

As planned all polystyrene cups were successfully removed from the neonatal unit in August 2018 with no further purchases planned. This is expected to save the unit nearly £5000 per annum based on the previous year purchases. From an environmental perspective the project has prevented an estimated 96,000 per annum polystyrene cups entering landfill. The sale of the reusable alternative was popular with all 250 units being sold at a unit cost of either £8 on-site or £10 online.

With each unit costing £5.45 from the manufacturer the SSNAP charity raised at least £637.50 that could be re-invested into their charitable funds.  Overall the project was well received and staff were happy with the removal of the single use cups. Some staff did comment that is took some time for them to get into the habit of remembering to bring their own cup to work but it was a habit they were pleased to adopt.

Media coverage for the project included an article in the local newspaper, local radio and a low carbon newsletter for Oxford. It is hoped that this coverage helped support a change in attitude and install a sense of pride.

How This Improvement Will Be Sustained

A sustained change in culture towards environmentally friendly practice is likely to take time to be embedded. However, it is likely that as a few individuals adopt this approach larger groups will be impacted and change will be self-promoted. It is hoped that the poster campaign will act as a reminder to staff and encourage more sustainable decision making.

Challenges and Learnings

A particular challenge in this quality improvement project was centred around the use of the reusable cups allocated to each cot-space for the exclusive use of parents. Unfortunately, despite these cups being clearly highlighted with an alert that they were exclusively for parents and not to leave the neonatal unit, a number of them went missing. On a few occasions it appeared that staff would use the cup and then store it in their locker for repeated use.

It is also unclear if parents were taking the cups home with them. To try and overcome this an email reminder was sent out to staff highlighting the intended purpose of the cups. It is hoped that over time this message will be disseminated amongst staff and improvements will be seen.

Suggestions For Further Implementation

Although this quality improvement project has helped change one aspect of sustainability, there remains huge scope to improve other areas of healthcare and daily living. This is particularly the case in the intensive care setting where medical devices and single use equipment is heavily relied upon. Paediatrics and neonatology offers itself as the ideal specialty to consider novel ideas in sustainability as our focus is on protecting the future generation.

Project Lead: Dr Claire Roome (Paediatric ST3 in the Thames Valley Deanery)

Organisation: John Radcliffe Hospital Neonatal Unit

Published: November 2019