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Medicines

Moorfields has proactively moved beyond standard NHS guidance to explore innovative and specialty-specific sustainability practices in ophthalmic medicine.

Our progress so far

Moorfields has successfully implemented key actions outlined in NHS England’s green plan guidance on medicines. We eliminated desflurane from anaesthetic use in 2022, followed by the complete discontinuation of nitrous oxide in anaesthetic procedures at our City Road site in 2025. 

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Furthermore, we transitioned surgical cryotherapy from nitrous oxide to carbon dioxide, which has a nearly 300 times lower global warming potential. We have therefore chosen reducing pharmaceutical waste as a key focus of the Medicines section of our green plan.

Recycling pharmacy waste

In 2025, our A&E nursing and pharmacy teams collaborated to reduce medication waste by re-labelling and returning mislabelled stock. A designated box was introduced in A&E for staff to deposit such items, which the pharmacy team now collects twice weekly as part of routine operations. This initiative has successfully reduced both waste and cost.

Moving from single-use eye drops

The Moorfields medical retina service, with support from pharmacy and infection prevention and control, has led a pioneering sustainability project with the potential to significantly reduce the carbon footprint and plastic waste associated with eye care via eye drops.

Single-use eye drop formulations, while convenient and sterile, generate substantial amounts of plastic waste at 1 gram of LDPE per dose. As part of a green initiative, the medical retina team launched a pilot to trial multi-use eye drop bottles, which can treat up to 25 patients at only 7 grams of LDPE per bottle.

The three-week pilot involved transitioning 953 patients from single-use minims to multi-use bottles, alongside comprehensive
training for technicians and nurses on proper handling and administration techniques. The results were promising and once implemented across all medical retina satellite sites, this is projected to result in the avoidance
of 67.6 kg of plastic waste, 141.89 kg CO₂e, and savings of £86,953.93 annually.

Given that ophthalmology is the busiest outpatient specialty in the UK, even modest changes like this can yield major environmental and financial benefits. Our specialist doctor in medical retina shared the success of the project in an online presentation at the 2025 London Greener Celebration event series by NHS England.

Medicines plan

Action KPIs
Reduce waste from medication
Reduce plastic waste by transitioning to multi-dose eye drops.  
  • Complete roll out of Tropicamide multidose eye drops across medical retina by end of 2026. Potential to save 67.6 kg of plastic waste, 141.89 kg CO₂e annually.
  • Increase usage and promotion of multidose preservative-free eye drops throughout Ophthalmology e.g. Latanoprost use by patients in the community during 2026: estimated potential to save up to 21,087 kgCO2e per year.
Recycle unused eye drops from clinic areas to reduce waste and costs.
  • Continue collecting and returning mislabelled medications from A&E twice a week
  • Conduct an audit to identify the root cause for high quantity of mislabelled medication in A&E and put measures in place to prevent this from occurring
  • Scope other clinical areas where unused mislabelled medicines can be returned to pharmacy for recycling
Explore sustainability opportunities in the procurement of medicine.
  • Liaise with pharmaceutical companies to explore the feasibility of manufacturing single-use eye drops in multi-dose vials
  • Maintain appropriate stock holding by continuously analysing pharmacy dispensing data to avoid wastage from expired stock
Build on work done to date to rationalise procedure packs to inform general use of clinical consumables.
  • Review high-use packs by 2028 – as an example, review of retinal therapy unit injection packs in 2026.
Reduce drug wastage during high seasonal temperatures.
  • Review ‘Flowchart for Temperature Excursion Event’ Standard Operating Procedure in 2026. 
Reduce plastic waste by recycling eye drop bottles.
  • Initiate conversations nationally regarding recycling of medicinal packaging, involving conversations with vendors and national bodies.
Reduce carbon footprint on courier deliveries.
  • Reduce the insulin eye drop delivery by 50% following confirmation of product stability by manufacturing company and extension of the expiry date from 14 to 28 days.
    ● Encourage patients to collect medicines where possible (within M25 region).