Green nudges for sustainable anaesthetic practice: institutional support to make individual change easier

Parker, Joshua; Young, Paul; Hodson, Nathan; Shelton, Clifford L.

doi:10.1111/anae.15991

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…Behaviourally, the use of mobile cylinders makes nitrous oxide use an active clinical choice, as cylinders must be retrieved and connected to the machine. This may act as a ‘nudge’ to further reduce use [33].…”

Section: Implementation Case Studiesmentioning

confidence: 99%

The Nitrous Oxide Project: assessment of advocacy and national directives to deliver mitigation of anaesthetic nitrous oxide

Chakera,

Harrison,

Mitchell

et al. 2024

Anaesthesia

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SummaryThe environmental emissions attributed to anaesthetic nitrous oxide across the NHS are comparable to the carbon dioxide released by 135,000 flights from Frankfurt to New York. Much of these emissions are attributable to cumbersome and inadequately managed piped systems, resulting in excessive loss and waste. Since 2020, multiple hospital sites have been engaging with the Nitrous Oxide Project, a quality improvement method supporting a ‘lean systems’ approach to the provision of nitrous oxide. This review considers the frameworks supporting medical gas management in UK healthcare systems, and the impact of professional advocacy and medical gas stewardship to drive anaesthetic nitrous oxide mitigation in the NHS. Nitrous oxide mitigation efforts by grassroots and professional advocacy networks are enhanced through national centralised emission monitoring, distribution of data, technical information and provision of quality analysis. Given the climate harms of nitrous oxide, concerted efforts should be made to rationalise its use, and resources should be committed to supporting this at local, regional and national levels.

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Section: Implementation Case Studiesmentioning

confidence: 99%

The Nitrous Oxide Project: assessment of advocacy and national directives to deliver mitigation of anaesthetic nitrous oxide

Chakera,

Harrison,

Mitchell

et al. 2024

Anaesthesia

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“…report the experiences and impacts of undertaking the Nitrous Oxide Project in three different institutions [14]. Discussion of the challenges encountered illustrates that even when the right thing to do is obvious, there is often a gap in understanding how to encourage individuals and institutions to use drugs, technologies and techniques more responsibly [15].…”

Section: Development Adaptation and Evaluation Of Technologiesmentioning

confidence: 99%

“…They note that behaviour is seldom simply a rational response to information and go on to describe a programme of research informed by behavioural change theory which will focus on three pillars: re‐usable operating theatre textiles; anaesthesia; and waste reduction. The Behaviour Change Wheel model has been used recently to help understand why anaesthetists may adopt more sustainable practices, emphasising the growing research interest in the application of behavioural theories in accelerating change towards sustainable peri‐operative care [15, 19, 20].…”

Section: Implementation and The ‘Triple Bottom Line’mentioning

confidence: 99%

Sustainability is a core outcome: filling research gaps in sustainable peri‐operative care

Shelton,

Lentzos

2024

Anaesthesia

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“…Elsewhere, a number of nudges have been suggested: labelling, positioning green alternatives as the default, creating a departmental environment of pro-sustainable anaesthesia, peer comparison and social commitments. [58] As these shift the choice architecture, what is ultimately required is structural change. Again, these are second-order responsibilities that incentivise, enable or create certain norms that ensure individuals fulfil their first-order responsibilities.…”

Section: Green Nudges and Sustainable Practicementioning

confidence: 99%

How should institutions help clinicians to practise greener anaesthesia: first-order and second-order responsibilities to practice sustainably

Parker,

Hodson,

Young

et al. 2023

J Med Ethics

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There is a need for all industries, including healthcare, to reduce their greenhouse gas emissions. In anaesthetic practice, this not only requires a reduction in resource use and waste, but also a shift away from inhaled anaesthetic gases and towards alternatives with a lower carbon footprint. As inhalational anaesthesia produces greenhouse gas emissions at the point of use, achieving sustainable anaesthetic practice involves individual practitioner behaviour change. However, changing the practice of healthcare professionals raises potential ethical issues. The purpose of this paper is twofold. First, we discuss what moral duties anaesthetic practitioners have when it comes to practices that impact the environment. We argue that behaviour change among practitioners to align with certain moral responsibilities must be supplemented with an account of institutional duties to support this. In other words, we argue that institutions and those in power have second-order responsibilities to ensure that practitioners can fulfil their first-order responsibilities to practice more sustainably. The second goal of the paper is to consider not just the nature of second-order responsibilities but the content. We assess four different ways that second-order responsibilities might be fulfilled within healthcare systems: removing certain anaesthetic agents, seeking consensus, education and methods from behavioural economics. We argue that, while each of these are a necessary part of the picture, some interventions like nudges have considerable advantages.

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Green nudges for sustainable anaesthetic practice: institutional support to make individual change easier

Cited by 4 publications

References 34 publications

The Nitrous Oxide Project: assessment of advocacy and national directives to deliver mitigation of anaesthetic nitrous oxide

The Nitrous Oxide Project: assessment of advocacy and national directives to deliver mitigation of anaesthetic nitrous oxide

Sustainability is a core outcome: filling research gaps in sustainable peri‐operative care

How should institutions help clinicians to practise greener anaesthesia: first-order and second-order responsibilities to practice sustainably

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