IMPLEMENTING A CLINICAL DECISION SUPPORT TOOL TO MINIMIZE NITROUS OXIDE USE

The purpose of this project was to reduce greenhouse gas (GHG) emissions related to anesthetic gas usage by implementing a clinical decision support tool (CDST) into the electronic medical record (EMR), reminding clinicians to minimize or avoid the use of nitrous oxide (N2O) in the operating room (OR) at a Southern California Kaiser Permanente (KP) facility. This project built upon a previous doctoral project that examined the effects of provider education, attitudes, and other characteristics on reducing nitrous oxide use in the OR at the same KP facility. Baseline nitrous oxide usage in terms of liters per minute flow and duration of use in minutes was compared with liters per minute flow and duration of use in minutes in March, April, May, June, July, and August 2021, after implementation of a CDST into the EMR flowsheet. When compared to baseline data, there was no statistically significant reduction observed in nitrous oxide use in liters per minute (L/min) flow (p=0.406) or duration of use in minutes (p=0.333) after CDST implementation. While there was no statistically significant difference in mean L/min flow, a marginally significant difference in median flows (p=0.061) was observed, suggesting the existence of outliers within the data. Further study is needed to examine and understand individual provider characteristics and practice habits, which may aid in determining more effective strategies leading to sustainable change in provider practice