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• W4381430595 abstract "Background: More than 90% of UK Caesarean sections are done with neuro-axial blockade.1 Until recently, the main ways of testing the level of neuro-axial blockade in anaesthesia has been through checking the modalities of coarse touch with a neuro-tip or more prevalently using ethyl chloride to assess temperature. Ethyl chloride is an aerosolised spray of chloroethane (chemical formula C2H5Cl) which is both costly and harmful to the environment in its generation of waste, not to mention the carbon footprint produced in its manufacture and transportation. An innovative new piece of equipment called ‘cool sticks’ piloted by a group in Bournemouth for the OAA 2020 Green ward competition, achieves similar levels of discrimination when assessing the level of neuro-axial blockade with several advantages over the traditional ethyl chloride, including reduced waste, reduced cost, and a lower carbon footprint. Our team hope with the cool sticks in place, the NHS target of net zero emissions by 2040 is closer to being achieved. We also hoped to see a significant cost saving as ethyl chloride is replaced by this greener more sustainable method. Our aim was to reduce ethyl chloride usage in obstetric theatres by 50% in 3 months. Methods: Ten cool sticks were obtained from the supplier along with contact details of other anaesthetic departments currently using the equipment. This helped define our initial trial target (elective and emergency obstetric theatres not including labour ward) and our key secondary indicators: acceptability and ease of use for the block level assessors; and effectiveness of block level discrimination compared with ethyl chloride. Cool sticks were then demonstrated to the anaesthetic and theatre staff for a trial period of 3 months, during which time ethyl chloride usage was monitored. Staff were surveyed at the end of this period. Results: Median ethyl chloride purchasing over the 3-month trial period dropped from 62 units/month to 35 units/month. Of the anaesthetists surveyed who had used the cool sticks 100% of them found the cool sticks to be at least as easy to use as ethyl chloride, with 56% finding them easier to use. Equally, 100% of anaesthetists found the cool sticks as effective at assessing the level of neuro-axial block compared with ethyl chloride with 67% finding them to be a better discriminator. Conclusion: Initial findings suggest cool sticks do reduce ethyl chloride usage. The projected cost saving per annum based on this quality improvement project (QIP) would be £6480. Long-term data are being collected to confirm purchasing does remain low and projected savings are accurate. Anaesthetists mostly prefer the cool sticks for assessing block levels. Our group aims to collect more data as this new practice is translated to the labour ward and other hospitals within the trust. 1.Bamber JH, Lucas DN, Plaat F, Russell R. Br J Anaesth 2020; 125: 580–7" @default.
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• W4381430595 date "2023-06-01" @default.
• W4381430595 modified "2023-09-28" @default.
• W4381430595 title "Reducing ethyl chloride usage with innovative cool sticks" @default.
• W4381430595 doi "https://doi.org/10.1016/j.bjao.2023.100153" @default.
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