While hospitals play a central role in healing, it is contradictory that healthcare activities contribute to climate change, ultimately creating a less healthy world. To achieve the goals of reducing waste and climate impact established to address this issue, action must be taken. Medication is responsible for a large share of Erasmus MC's emissions. However, research into the environmental impact of medication is still in its early stages. In particular, the impact of medication packaging remains largely unexplored and must first be mapped. For this purpose a Material Flow Analysis (MFA) was executed at the Intensive Care Unit (ICU) of Erasmus MC to assess its current environmental impact and to identify environmental hotspots (for potential reductions).
 
Patient care in the ICU is highly specialised and personalised, and medication plays a critical role in this. Medication packaging is composed of several components. The components included in this MFA study are primary packaging, secondary packaging, leaflets and accessories. All components come in many different shapes.
 
For all medications prescribed more than 250 times in 2023 within the ICU, the components of the packaging were assessed by weight. The three major hotspots in terms of material are plastic, glass and paper. A significant finding in terms of packaging was the share of dialysis bag boxes. These boxes alone account for 20% of the waste in the ICU.
 
In the second part of this study a redesign of the dialysis bag boxes was proposed. To redesign the dialysis bag boxes, their packaging was first examined and the surrounding system was mapped. The redesign process utilised the Circular R-strategies from Metabolic’s Value Hill to reduce waste and the environmental impact of the packaging. During the ideation phase, two strategies were prioritised: reducing the paper content of the packaging and introducing reusable packaging. A cost analysis revealed that reusable packaging is both more sustainable and more cost-effective over time compared to single-use paper boxes. Existing reusable systems in healthcare and other industries, such as the fruit and vegetable sector, were also explored for inspiration.
 
From the ideation, four concepts were developed, and a final concept was selected: a dolly system combined with a box with a lid. This box can be sealed and is stackable and nestable, which is essential for transport and storage. Additionally, the reusable box is more user-friendly, saving nurses time and allowing them to focus more on critical patient care. By implementing this concept, 20% of the waste generated in the ICU can be eliminated.
 
This research primarily aims to highlight the challenges within the complex healthcare system and serves as an eye-opener for the industry to reconsider its strict regulations and environmentally harmful practices.