Reducing nitrous oxide use in theatres

Project completed as part of the Royal Devon & Exeter NHS Foundation Trust Green Team Competition

Setting/Patient Group: Trust-wide

Issue to be addressed:

5% of the carbon footprint of acute NHS trusts comes from anaesthetic gases. There are alternatives to nitrous oxide which maintain clinical outcomes without negative environmental impacts but are not yet normalised within the trust.

Intervention:

The aim was to eliminate nitrous oxide use (apart from maternity) within the trust. To do this the anaesthetics team used the following methods:

1. 1. Informal conversations with colleagues (face to face and email
2. 2. Measurement of carbon impact of nitrous oxide within trust to quantify environmental impact.
3. 3. An education session in departmental clinical governance meeting, followed by a debate.
4. 4. Application of reminder stickers to encourage minimal use of gas required for effective anaesthesia.

Cumulative outcomes:

Clinical

• Nitrous oxide has adverse effects on some patients including nausea and hypoxia.

Social

• Increase staff and patient wellbeing
• Increased staff job satisfaction

Environmental

• Estimated total carbon saving 2,607kgCO₂e/year

Economic

• Estimated total cost saving of £42,798/year

Key learning point

Sometimes we don’t get the result we hope for - the vote following debate fell in favour of keeping nitrous oxide rather than elimination as most anaesthetists wanted the option of using it.