Reducing the use of desflurane in anaesthesia
The trust has been working to reduce use of the most environmentally damaging anaesthetic gases to help meet its carbon reduction aims.
Desflurane, an inhalational agent used in anaesthesia, was responsible for 87% of the trust’s carbon dioxide equivalent emissions resulting from the use of anaesthetic gases.
Anaesthetists were asked to substitute it, wherever clinically appropriate, with sevoflurane, a less damaging agent in terms of CO2 equivalent emissions (9% of total CO2 equivalent (tCO2e) emissions from anaesthetic gases), which has a significant cost saving for each bottle.
The key intervention was to incorporate an environmental section into one of the regular conferences held by anaesthetists. This discussed environmental and potential clinical impacts, potential cost savings, and contribution to the trust’s overall sustainability agenda. All stakeholders, including pharmacy, estates, and facilities, were consulted. The anaesthetists agreed to default to using sevoflurane, except where desflurane was considered advantageous according to clinical judgment.
Use of desflurane has significantly decreased since the intervention. Monthly emissions have fallen considerably, down to 187 tCO2e in January 2020 compared with 517 tCO2e in January 2019.
Adam Newman, sustainability manager, said, “So far the feedback has been positive. The cost to pharmacy has gone down and there have been no medical repercussions arising from the change in use of anaesthetic gas. Assuming the success of the project continues, it will become ingrained behaviour and will be sustainable over the long term.”
This project was shortlisted for a BMJ award 2020.
Green Ward competition
The Trust held a Green Ward competition where a number of clinical teams identified projects that had potential for environmental or social improvement within their area and worked in partnership with the Centre for Sustainable Healthcare to improve environmental sustainability and reduce our carbon footprint.
The winners were Katy Mallender-Ward and Christine McNally from Radiology who have been working with their team on an initiative which reduces unnecessary visits by patients who are referred for an x-ray by their GP. Every referral is vetted by a member of the team who confirms whether the patient needs to attend.
This prevents inappropriate referrals and patients being turned away, therefore saving them and the department time, as well as reducing the carbon footprint.
ICU waste segregation and recycling project
The team on the Intensive Care Unit at St James's Hospital have taken part in an improvement project to improve waste segregation and recycling.
Clinical waste creates a number of challenges due to legislation, and the team have looked at new and innovative processes as well as alternative recycling bins and bags to support this.
The results so far have been very promising, with a significant increase in the amount of recycling on the unit, and better segregation between domestic and offensive waste which also creates a cost saving for the Trust.
Education has been key to their success - the more staff who have received training or briefings, the better their waste segregation and recycling.
The overall ambition, alongside recycling as much waste as possible, is to create a model that can be rolled out to other clinical areas in the future, contributing to our ambition of being one of the greenest Trusts in the country.