Nitrous oxide, a potent greenhouse gas, is a common labour analgesic. One method which may reduce its carbon footprint is to `crack´the exhaled gas into nitrogen and oxygen using catalytic destruction. In this quality improvement project, based on environmental monitoring and staff feedback, we assessed the impact of nitrous oxide cracking technology in the maternity setting. Mean ambient nitrous oxide levels were recorded during the final 30 minutes of uncomplicated labour in 36 cases and plotted on a run chart. Interventions were implemented in four stages, comprising: stage 1, baseline (12 cases); stage 2, cracking with nitrous oxide delivered and scavenged via a mouthpiece (eight cases); stage 3, cracking with nitrous oxide via a facemask with an air-filled cushion (eight cases); stage 4, cracking with nitrous oxide via a low-profile facemask, and enhanced coaching on the use of the technology (eight cases). The median ambient nitrous oxide levels were 71% lower than baseline in stage 2 and 81% lower in stage 4. Staff feedback was generally positive, though some found the technology to be cumbersome; successful implementation relies on effective staff engagement. Our results indicate that cracking technology can reduce ambient nitrous oxide levels in the obstetric setting, with potential for reductions in environmental impacts and occupational exposure.

Bench experiments to investigate the effect of nitrous oxide cracking technology in ideal circumstancesNitrous oxide (N 2 O) is a potent greenhouse gas, and occupational exposure has potential health impacts for healthcare staff [1,2]. Although the use of N 2 O can often be

Nitrous oxide is a common choice of labour analgesia in many countries. However, its use is associated with significant cost to the environment as well as potential risks of long-term occupational exposure. Our hospital is one of a small number of healthcare providers in the United Kingdom trialling technology which catalytically destroys (`cracks´) nitrous oxide to reduce greenhouse gas emissions and occupational exposure. When used in the setting of inhaled analgesia, cracking technology relies on capturing the patient's exhaled breath via a facemask or mouthpiece, a technique which requires some user skill and may be challenging for patients. In this report, we present the case of a primiparous 35-year-old consultant anaesthetist, who used nitrous oxide cracking technology with inhaled nitrous oxide analgesia (via a facemask) during labour. We present the patient's experiences and discuss the implications of using such technology on ambient nitrous oxide levels in the delivery room. Notably, despite this patient's professional expertise and familiarity with facemask use, nitrous oxide remained detectable throughout her labour, although generally at low levels. This illustrates that whilst this technology has the potential to reduce ambient nitrous oxide levels, its efficacy may vary depending on how it is used, with implications for patient education and support.

Significant improvement was seen in the completeness of information handed-over following the introduction of the new proforma with likely positive implications for patient safety and standard of care. Opportunity for improvement still remains however, and more specific focussed tuition for trainees is required.

AimAn audit of compliance with NICE guideline CG149 for the management of early onset neonatal sepsis (EONS) undertaken at this hospital indicated underperformance with respect to duration of antibiotic treatment and choice of benzylpenicillin dose. A re-audit was carried out to evaluate the impact of measures introduced to improve compliance, with a particular focus on duration of antibiotic treatment.MethodResults of the initial audit were presented to the department, leading to the selection of champions for change. An intervention strategy was devised, which comprised of introducing a new section to the neonatal handover list, whereby date and time when repeat CRP and review of blood cultures should take place was clearly documented, together with results as they became available. This intervention was introduced at a departmental meeting, and received enthusiasm from junior doctors and consultants. Both audits were retrospective, spanning 12 months and 5 months respectively. Data were retrieved from case notes and the Trust’s electronic laboratory management system.ResultsThe findings presented in the table 1 show that;audits analysed >75% of the cases of suspected EONS;proportion of babies receiving ≤48 hours of antibiotics increased from 18.5% to 69%;proportion of babies receiving a full 7 day course of treatment increased from 35% to 82%;compliance with benzylpenicillin dosing increased to 100%.Abstract G134(P) Table 1 Original Audit (12 months ) Re-audit (5 months ) p* Babies tested for suspected EONS, n 204 106 Casenotes reviewed, n (%) 159 (78) 80 (75.5) 0.95 Babies without sepsis receiving≤48 hours of antibiotics,% 18.5 69 <0.0001 Babies with sepsis receiving 7 days of antibiotics,% 35 82 0.02 50 mg/kg dose of benzylpenicillin used for meningitis only,% 0 100 <0.0001 *Mann-Whitney testConclusionIntroducing a robust system for ensuring the timely review of CRP and blood culture results has improved overall compliance with NICE guidelines, and in particular, has significantly reduced the number of babies receiving inappropriate durations of antibiotic treatment.