Ending Entonox Waste project
Entonox is a 1:1 mixture of Nitrous Oxide and Oxygen and is used primarily in maternity departments as an analgesic during labour, where its rapid onset and short duration of action are suited to intermittent use during contractions. Historically, it has also been used for similar reasons in paediatric and emergency departments but other analgesic options such as Penthrox are gradually replacing Entonox in these areas.
Nitrous Oxide (N2O) is a potent greenhouse gas and ozone depleting substance which persists in the environment for over 121 years. It has more than 260 times the global warming potential as carbon dioxide and research has shown that 4 hours of standard Entonox use in labour is equivalent to driving 1500km in an average sized car.
Nitrous Oxide emissions account for 2% of the total NHS emissions and Entonox represents approximately 2/3rds of all N2O emissions.
Investigation into the use of N2O within anaesthetics has established widespread leaks within the manifold systems (pipework) that deliver the gas, and as a result many hospitals are replacing these faulty systems, moving to bedside canisters with lower risks of leaks (1) , and working to drive down the use of N2O altogether. Early investigations into the manifolds (pipework) that deliver Entonox have begun to reveal the same problems, and a growing number of trusts are now looking at solutions to this problem.
What is the Ending Entonox Waste project?
The Ending Entonox Waste project has been created to share knowledge and empower NHS staff to drive down Entonox emissions, primarily through measures to prevent unnecessary Entonox waste by tackling gas leaks, but also through ensuring good access to alternative analgesics, and through the use of new technologies such as ‘cracking’ which break down exhaled Entonox into its harmless constituents.
Why is the Ending Entonox Waste project important?
Entonox on its own constitutes a significant proportion of NHS greenhouse gas emissions and yet the early evidence from pioneering trusts suggests just as with Nitrous Oxide, the majority of this gas is entirely wasted and never used by patients.
How will the Ending Entonox Waste project work?
By collecting together case studies from the trusts pioneering work on reducing their Entonox emissions, The Ending Entonox Waste project aims to increase awareness and knowledge and empower others to spread the solutions to the problem of Entonox waste.
The first stage is to collate case studies and information into one, easy to access library.
We will then plan a Webinar for teams/individuals working on the project
What does the Ending Entonox Waste project hope to achieve?
The potential of this project is huge, and the aim is to use this collated data to lobby NHS England to implement a holistic action plan to tackle the issue. Ultimately this will lead to national guidance on best practice to reduce Entonox emissions.
Resources
Catalytic Entonox cracking – real world experience Newcastle Upon Tyne
Listen to Katherine Whitehouse, consultant obstetric anaesthetist at the Royal Victoria Infirmary, Newcastle upon Tyne.
Entonox reduction at Hull University NHS Trust
Listen to Marc Beaumont, Sustainability lead at the Hull University teaching Hospital.
Life Cycle analysis of different modes of birth
Listen to Nienke Spil, Medical student at the University of Groningen and the University of Manchester NHS Trust.
Entonox mitigation at Aneurin Bevan University Health Board
Listen to Dr Jenna Stevens, a Consultant Anaesthetist within Aneurin Bevan University Health Board in South East Wales.
Environmental and occupational harms of Entonox, the Scottish approach to mitigating loss and what we have learned
Liten to Alifia Chakera, Head of Pharmaceutical Sustainability with Scottish Government’s Health and finance Directorate.
Minimising occupational exposure
Listen to Theresa Hughes, Retired NHS Trust Principal QA Pharmacist.
Talk 1 Entonox mitigation at King’s College, Talk 2 Remifentanil as a potential alternative
Listen to Dr Laura Stevenson and Dr Alice Clack.
CSH’s women’s Health Network
Please join CSH’s women’s Health Network and liaise with peers.
Further reading
- Nitrous oxide toolkit: Reducing waste in NHS trusts – UCLPartners
- Nitrous oxide project | Association of Anaesthetists
- CSH Nitrous Oxide Project
- CSH Desflurane Reduction Project
- CSH Anaesthetic Gas Scavenging System (AGSS) project
- NHS Scotland Entonox System Loss Mitigation and Management – technical update
Please contact Dr Frances Mortimer, CSH’s Clinical Director, for more information.