Nitrous oxide toolkit: Reducing waste in NHS trusts
Nitrous oxide and nitrous oxide/oxygen mixture, also known as ‘gas and air’ are used in a variety of settings across the NHS. Recent work has shown that the way these gases are supplied, through medical gas pipeline systems, can cause significant waste. Evidence shows leaks in these supply systems, alongside other issues, cause around 75% – 99% of the gases to be wasted.
This interactive toolkit has been developed to help NHS trusts to reduce nitrous oxide waste safely and efficiently. Through doing this work, there is an opportunity for NHS trusts to save time and money, improve operational efficiency and to reduce carbon emissions from nitrous oxide, a potent greenhouse gas.
The toolkit offers clear step-by-step guidance on how to reduce waste. This includes practical tools, case studies and advice from trusts to support implementation of simpler, smaller supply systems.
The toolkit has four main sections:
- Understanding nitrous oxide systems: this covers the basics of how the gases are used and supplied in clinical settings, helping staff understand where waste commonly occurs in their supply.
- Getting started: this provides practical guidance on setting-up waste reduction efforts, creating governance structures, engaging stakeholders and building effective project teams.
- Aligning supply with clinical use: this offers a framework for assessing usage of the gases and making informed decisions about transitioning to smaller, simpler supply systems.
- Optimising systems: this details multiple ways NHS staff can continue to reduce waste and increase efficiency in the supply of the gases, no matter the system being used.
There are 10 supporting additional resources that accompany the toolkit. These include a range of interactive and informational components such as calculators, editable action lists and project templates, as well as practical guides to support implementation.
Download the supporting resources below:
1. Nitrous oxide and nitrous oxide oxygen mixture use and supply in the NHS
2. Portable cylinder system options and equipment
3. Tool – Project management templates
4. Tool – Key actions checklist
5. Project communication templates
6. Approaches to understanding nitrous oxide supply and use
7. Tool – Measure and calculate emissions and waste
8. Tool – Supply system map and decision template
10. Process map for portable cylinders
In developing the toolkit, UCLPartners has worked closely with NHS staff and nitrous oxide user groups, including anaesthetists, dentists, pharmacists, midwifes, emergency department staff, estate managers and facility teams. This is to ensure that the toolkit meets the needs of multiple NHS organisations that use medical gas pipeline systems for nitrous oxide and nitrous oxide/oxygen gases. Consideration has been given to their different requirements for each gas, their contexts and operating environments to ensure the toolkit is actionable for all.
Thank you to all the NHS staff who have contributed their time and efforts to create the toolkit and help ensure that it provides useful and enduring advice for those working to reduce nitrous oxide emissions in healthcare. A special thanks to Alifia Chakera, Head of Pharmaceutical Sustainability at NHS Scotland, whose leadership of the national Nitrous Oxide Project has been instrumental. Her relentless advocacy has driven meaningful improvements for both patient care and the planet.