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Excellent. All right, I'll get started. Um Thanks for having me, everyone. It's exciting to be able to share this um pilot study with you that we conducted in Sydney um at one of our main tertiary hospitals and we work to reduce the use of calf compressors in intensive care. Um And so just as a little bit of background for your wall, um venous thromboembolism or VTE accounts for 7% of deaths in Australian hospitals, which is quite substantial. And um clinicians use AAA mix of mechanical and chemical prophylaxis techniques um to reduce the risk of VTA. And that includes things like um uh mechanical calf compressors. Um but also includes um drugs such as heparin or enoxaparin as well. There is really strong evidence now though to suggest that calf compressors when they're used in combination with chemical prophylaxis like heparin don't provide any additional reduction in risk of VTE. And so we start to actually now question, well, why are we using calf compressors so often in clinical practice when they really could be now considered as low value care in lots of instances. And so because of this, we embarked on a before and after study, um to assess the effect of the implementation of an education package to reduce the unnecessary use of calf compressors in the ICU. And in terms of our secondary objectives, we're also interested to determine the change in cost waste and carbon dioxide equivalent associated with our change in calf compressor usage. And we also wanted to identify the impact of education um on staff behavior as well. And so this is just a little bit of a map of um the process that we undertook. So we had a single center um intensive care unit at Royal North Shore Hospital in Sydney. And we were interested in any new pa any patient, sorry, in ICU that had a new pair of calf compressors fitted. And what we did was conducted a um preeducation audit that looked at our patterns of usage in terms of our ordering patterns as well as nursing staff usage. We also collected the weight of a single product, the cost of a single product and the carbon footprint or the basic carbon footprint, I should say of a single product too. We then went into the staff education phase. Uh sorry, that first measurement phase was three months. Um Our staff education phase also was three months which I'll talk to in a little bit. And then our final post education um audit phase was just re looking at the patterns of use again, in terms of our ordering patterns and again, our staff usage and that ran for three months as well. And so our education particularly focused on nursing staff as they are the main people that are fitting calf compressors in intensive care. And so we did face to face education sessions with the nurses um as frequently as we could over that three month period, we also provided an in service to doctors as well just to guide their prescription use of calf compressors. We put together this um visual decision making table as well, which was particularly for nursing staff. And we used that color coordinate coordinator system of red and green to suggest when it wasn't and was appropriate for um patients to have calf compressors. We also hung posters around the unit which you can also see pictured there um and put these posters up electronically on our sharepoint internet page too. Um And the other thing that we did was also um limited access to calf compressors and the pumps that are used with the calf compressors off the floor to a storeroom so that it was much harder to access um the product itself. And so these are some of the results. So in our preeducation audit phase, um we found at the overall unnecessary use of calf compressors was at 56.9% and that was across three sort of smaller units within a large intensive care unit um as well. And you'll particularly notice there are cardio cardiothoracic unit were um using calf compressors unnecessarily in 100% of cases um of, of patients that we audited, which was quite substantial. But in our post education um audit, we discovered that we had made quite a substantial impact on, on a calf compressor usage with our overall unnecessary use down to 9.7%. But in particular, in that cardiothoracic unit, we um had staff not using calf compressors inappropriately inappropriately at all, which was really fabulous. Um This is the basic carbon footprinting that we did for a pair of calf compressors. So we just did a really simple um bottom up um process analysis of of a single pair of calf compressors including their plastic packaging. And as you can see there, one pair of calf compressors has 432.24 g of CO2 equivalent. Um We also looked at the costings of our calf compressors. So a single pair of calf oh A box contains 10 pairs of calf compressors. So a single pair of calf compressors costs $17.46. And the weight of our calf compressors is also 100 and 24.704 g as well. And so we're able to have a look at our um based on our usage patterns, we were able to determine with the unnecessary use of calf compressors how much we were contributing from a carbon dioxide equivalent. Um point of view as well. As financial and waste as well. And so you can see there in that box, um that we again, substantially reduced our co2 equivalent, our costing and waste associated with our unnecessary calf compressor use. And in terms of our ordering patterns in the three months leading up to the education package, we ordered 19 boxes of calf compressors and post education. We only ordered eight boxes of calf compressors. So again, it, they matched that reduction in our use of calf compressors too. Um We also surveyed our nursing staff and so we have um 211 full-time nursing staff working in our intensive care unit. So we're able to capture almost half of our staff working there. And overwhelmingly, the staff were aware of the the project that was running, which was great. They found the education resources really helpful, which was also excellent and it was really great feedback to find out that the visual decision making tool that colored table of red and green was the most useful tool in guiding their clinical practice as well. And finally, we also asked staff if um they changed their clinical practice based on the education that they received and overwhelmingly staff said yes. Um they did, which was really exciting. Um So there were some limitations with the study that we conducted. It was a really small audit primarily because it was really difficult to do with our regular staff changes and high patient turnover as well, it was quite tricky. And so the numbers that we received back in our audit were quite small. We had 58 patients in the preeducation audit and only 31 patients in the post education audit. Um, but it still represents sort of a, a small um, minimum value, I guess of the impact that we can have um from an education package to reduce unnecessary use of something in ICU. Um And the other limitation was just the simple bottom up carbon analysis that we did for the calf compressors. It is a very basic overview of, of the carbon dioxide equivalent. But again, it represents a nice minimum value. Um noting that our emissions from calf compressors are probably much more substantial than what we're quoting them to be. There was AAA life cycle assessment previously done of calf compressors in the USA. Um But results of that study were quite difficult to generalize to an Australian context, which is why we chose to do our um simple bottom up carbon process uh carbon analysis ourselves. Um But we did find that the staff education did lead to a reduction in the number of calf compressors used in the unit. And we saw an improvement as well in the rate of appropriate use of calf compressors, which was great. And the reduction in half compressors um brought about a change in greenhouse gas emissions, a reduction as well as a reduction in waste production and financial savings as well. So all in all it was a really successful project and we're really hoping that we can partner with some other hospitals um around Sydney um in New South Wales to try and um upscale this project and, and see more sites um reduce the use of car compressors as well. And that's it for me. Thanks everybody. Brilliant. Thank you so much, Louise. That was fantastic. Um And so if you have got any questions for Louise, please put them in the chat and we will come back to them at the end of all our presentations. Um I'd like to hand over now to Stephanie, who I think has sorted out all her tech problems. Hi, Stephanie. Hello. I'm so sorry about the fall. No, no problem at all. Can you, you can hear me? Ok now? Yes. And, and we can, how can you even perfect? I'm going to make it short just because I know that I wasted a lot of time and I'm aware of other people speaking, so I'll just try and be as brief as I can. Um So my name's Steph. I am an adult intensive care nurse in London and I am also the clinical lead for sustainability um at my hospital and our sister hospital. Um and I'm also working as a hybrid nurse. So basically what that means is I um was working on a lot of sustainability projects within my hospital and employed my uh seniors to give me paid time to work on this. Um And my matron allowed me to, which was very kind um And gave me some funding for that. So I have one day per month at the moment that I actually get paid to work on sustainability. Um Next slide, please. So the objectives of the slide show are to just talk about one of the main projects I've been working on, which is energy conservation. Um And looking at intensive care in particular and the amount of energy that we use and how we can reduce that. Um So looking at the goals, the solutions, the challenges and the results and impact that we've had and what we can learn from this project. Moving forward. Next side, please. Thank you. So what was the problem? Energy usage and healthcare facilities. So major contributors are heating, ventilation, air conditioners and lighting and the lack of specific data on the energy usage in ICU S and limited literature. Um means that there's a lot of scope for us to do further research and um initiatives. Um um The team involved comprised diverse expertise of key stakeholders. So it included um our energy estates manager, our state manager, a sustainability consultant who was um paid by the trust to work on our green plan. Um And a few other key stakeholders including chief exec and Dean of Nursing. Next side, please. What was the solution? So basically the reason that um I decided that we were gonna work on energy was because when I joined the Sustainability Development Group, um we didn't have the data available for procurement in terms of um carbon emissions attributing to procurement. And so what we could see was that 95% of the emissions that we could track were actually coming from energy usage. And we had no way of actually finding which units we're using the most energy. And so just kind of by using common sense where you were able to establish that theaters and I CS and you know, previous studies as well have shown us that they are the biggest areas of energy usage and what were the ways that we could reduce our energy usage? Um And so we came up with two main strategies. The first one was on lighting, which is pretty self explanatory. So changing from fluorescent lighting to led and the light fittings to led um and the temperature control. So, having a wider variation of temperature control before we have cooling and um heating mechanisms come into play, which would save us a lot of energy. Um So it has taken a lot of time, it's taken a lot of collaboration. Um And it's taken funding as well for this to go through. Um But ultimately, it's leading to a lot of cost savings um and environmental savings, which we'll talk about in the results next slightly. So, what were the challenges? So, um we did look at ventilation and two of our isolation rooms actually, um because they were newly installed, um a few years ago, they have a separate um, air conditioning hanger, um which means that the ventilation is separate to the rest of the unit. And so we were looking at whether we could have a setback mode of the ventilation when um we found that on an audit that those rooms are only occupied 60% of the year. Um And so we talked to infection control um about, you know, reducing the settings. So almost a standby mode and then having a switch that we can turn on when patients would come in. But there was some concerns about um infection control and, and forgetting to turn the um to turn the switch back on the ventilation would return to normal. So that's something that we're looking to explore in the future, but we just shelled for now. Um seasonal factors. So that was changing the lights over because we couldn't do it obviously, when patients were in the room. So we've now done most of that in the summer. Um when we've had less patients, an unexpected delay. So, um that was in terms of getting in contact with our contractors and um getting everything installed and communicated. Um and just having third parties can, can make it a little bit more difficult sometimes to streamline. Next slide, please. What were the results and impact? So, the project is still ongoing. I'd say we're probably about 70 75% done. Now, um Lighting, we've only got one hallway left to install and then in future, we might be looking at sensor lighting as well. Um But we have got calculations based on the intervention. So uh the lighting itself, we found that we could be saving 7500 lbs, 21,000 kilowatt hours and 4.4 tons of CO2 emissions in ICU my ICU alone. And so um this and the temperature control, we're hoping that we can roll this out across the rest of the hospital and the rest of the trust. So we would have monumental savings and the temperature control. So this is based on one degree difference before the heating and cooling mechanisms will come into play and amounts to about 4000 lbs. Um 36,000 kilowatt hours and 6.7 times CO2 emissions. And um yeah, obviously, these numbers are massive. So if we can have, have a big impact, we can share it nationwide. Uh We've be so much, please. What were the learning points, collaboration, key, key stakeholder, engagement and education are essential. Um It would not have been possible, had my estate manager not been um on board with this project and has been really supportive, as I said, um it did require some upfront costs. Um So for the lights, we needed to get funding approved to change the lights over. Um but in the long run, we're going to be saving a lot more money and recommendations for others embarking on similar projects. So engage with keyholder early. So everyone is involved. Everyone feels like their um their voice is valued, prioritize education and awareness raising initiative. So everyone is aware of what's happening and feel they um that they're part of the collaboration and consider the unique needs of each environment that we are changing. Um our energy requirements for next slide, please. Once, once next. So I think I briefly spoke about this but yes, um scaling it up and using the network that we already have that we've built um to make it a large scale project. Um And we this project because the results, we don't have the finite results as of yet. Um We have written a study protocol which will be coming out in the B AC and sustainability issue. Hopefully later this year, we can read next slide. I think it's just um Q and A. Um But I don't know if you've got time for that now. Uh I have to rush off because I'm actually on holiday at the moment. Um But if anyone wants to email me, please feel free. Um And this is the name of the protocol that I mentioned. So if you see it in the stability issue, um you can read a bit more about it. Brilliant. Thank you so much, Stephanie for joining us today from, from your holiday for me. Um And yeah, do do go back to Stephanie if you've got any questions? Um Yeah, enjoy your holidays, Stephan. Thank you so much. All right, take care. Thank you. Bye. Um I pass on to Rosie Hay now who will present on behalf of Rachel Darling Sheffield teaching Hospital, who couldn't be here today and she's looking at the financial and environmental impact of sending phlebotomy trays for unnecessary external steam sterilization. Over to you Rosie Fab. Thanks Inga. Yeah, hi, everyone. I'm Rosie. Um I'm a sustainability analyst at the center for sustainable healthcare. And like Ra um Inga mentioned Rachel's unable to be here to present a project. So I'm gonna do my best to present a brief overview on her behalf. So this project was completed by Rachel darling and her team as part of the 2023 24 Sheffield teaching hospitals, green team competition. So I wasn't involved directly in the project, but I did support the team in calculating their carbon emissions. So um the sexual health team, they use those blue phlebotomy trays to temporarily store um different consumables and components required to collect patient samples um and also to place uh treatment in prior to administration. So, historically, these trays have been sent for weekly steam sterilization uh off site. But actually, when Rachel looked into why they were being off site to be sterilized, the rationale for this was unclear and So her and her team, they went and spoke to the infection control team at her trust and they confirmed that there was no barrier to them being cleaned in the clinic with the Tristel solution and uh cloth rather than being sent off site. And actually, they also spoke to other departments who were also using these trays and they found that they were also cleaning their trays on site rather than sending them off to be sterilized. So therefore, they, they had no concern um that patient safety would be compromised. Um So they discussed all of these findings with uh the senior management team and also the department service manager and they managed to implement the changes to the policy immediately. So in terms of outcomes, um you can see all of the outcomes on the slide, but if we look first at the clinical and social outcomes. So Rachel mentioned that once they received the sterilized trays, um they came in lots of packaging and so previously, it took up a lot of staff time to unpackage all of these trays. And she also mentioned that there were um sometimes delays to patient care as staff members had to unpackage these newly received blue trays um in order to undertake the sampling, but now the trays are cleaned with the Tristel solution and uh the cloth which they're already available in each clinic room. Um and it just saves a bit of time. Um And they have to spray down the surfaces at the end of each um patient session anyway. So it's kind of already ready to go in terms of social impact. Uh They undertook a staff survey and I think they got around 15 staff members to complete it. Um And from this, um they found that 73% of team members responded that they were very concerned about waste and the environmental impact of their care. Uh 6% were sometimes concerned and 20% had um never considered it. But she also mentioned that the project brought a real boost to morale within the clinic and that multiple team members have since approached Rachel with further ideas and um further areas for improvement and sustainable action in terms of financial impact. Interestingly, the change was cost neutral as the department already pays for a minimum service charge for sterilization requirements and then looking at environmental impact. So 13 trays um were being sent for sterilization per week which equated to 21.48 kg of carbon oxide equivalent. And then if we were gonna extrapolate that buildings across a year, this would 1116 kg of carbon dioxide equivalent, which is roughly the equivalent to driving 3298 miles in an average car. Um But Rachel also mentioned that ending this sterilization off site might prolong the lifespan of the trays um because they're not constantly being damaged and wrapped up from the sterilization process which might lead to additional savings in terms of how the team calculated the carbon footprint for the greenhouse gas emissions associated with the sterilization process. Uh The team used figures from a 2022 paper by Chantel Riza who had already estimated the carbon footprint of steam sterilization. And it was assumed that the steam sterilization process in the paper was very similar to the sterilization process used by the company who were decontaminating the phlebotomy trays. So that's the sterilization. Um And then for the greenhouse gas emissions associated with transporting the trays from the hospital to the sterilization site. And back again, the team were able to find out the distance and the type of vehicle used. And then they were able to convert this data um into carbon using figures or conversion factors from the UK government database. And then finally, the team, they also included the greenhouse gas emissions associated with the packaging that was used to wrap the tray in once they were sterilized and um sent back to the hospital. So a couple of the trays were wrapped in a couple of layers of paper and poly. Although I think the larger trays actually were wrapped in a polypropylene which is kind of the same material as a gown. Um So the team weighed each of these materials again, found emission factors for these raw materials using the UK government database and then converted that into carbon um to sum up this project. I just wanted to leave you with a quote from Rachel. This quote was taken from her report, which I will link in the chat. But I think it's a really lovely takeaway. So she's written, this is a very simple change of practice, challenging and unnecessary process that continued only because it was seen as a routine. Um Although a small project, it can hopefully be the start of a positive change in the clinic. Staff now have a contact in the sustainability team and feel that if they question why something is done, they can push for an answer rather than accept practices as routine and how it's always been done. Thank you very much, Rosie Rie. You are here. Would you like to comment or add anything? Uh Yeah, just to say that um when Rachel did they initially did the staff survey, um she, she wondered why she got very few responses to er, and feedback from that staff survey. And it was because the most junior members of our staff, I in our team didn't think that they had a right to fill it out. The survey didn't feel like they kind of had a voice and I think through just doing this kind of project, you know, that we've been able to work with those members of the team and that they do have that voice. And, you know, we're thinking about how we're gonna capture that and I think that, that quote from Rachel sums, sums it up. Really. The, the staff now have a voice and are now questioning and, you know, it's brilliant and the team are, you know, they did this as part of the Green team competition, but it's really spurred them on and it's a spring into what's next. And so another one of the projects that some of you will have heard on the reusable tourniquets, they were, they, you know, they immediately wanted to do that. We want them in, we want them in the clinic. Um But, you know, they're also looking at all other aspects of um single use items within the sexual health clinic and, and seeing, you know, what can be um adapted or changed to a reusable items and what does that mean? And what does that look like? So they're really, really spurred on by um you know, completing or being a part of the, the green team competition supported by the Center for Sustainable Health. So, yeah, it was uh it was a small project but the, the impact of it outside of just the carbon footprint, all the financial savings, all the social value, you know, have been massive in this team. So it's, it's brilliant to see. Great. And thank you, Rachel, it shows how, how important these projects are also to, to boost staff more and get started on the sustainability journey. A really good, good to see. Um before we answer any question, I pass on to our last speaker which is um Caroline Daughton from Sheffield teaching Hospital talking about her project on rationalizing drugs in the operating theater. Um Rachel over to you. Oh, just go back to the first slide. Excuse me? Hi. So my name is Caroline Dalton. I'm a nurse and the lead practitioner of the post anesthetic care unit, which is essentially a recovery at Sheffield's Teaching hospital. Um I recently took part in a green team competition in collaboration with the Center for sustainable Health Care from September to December 2023 alongside Doctor Tim O who's a consultant, anesthetist and sustainability lead for anesthetic and operating services. And Matt Clark who's the principal pharmacist for medicines Information. My co presenter is Rachel Cotton, who is the strategy and planning manager S th who also supported us during the green team competition as well. So the title of the report was rationalizing drugs in the operating theaters and to give some background just whilst generally safe anesthesia is a speciality with high risk of adverse reaction that requires rapid management. So for this reason, a range of medications are made immediately available in theaters, theaters, stop medications that are really used, they expire and opened and require disposal and replacement. Medicines are a major contributor to the carbon footprint of the NHS, accounting for 20% of all emissions and in 2015, in an NHS England paper the pharmaceutical waste reduction in the NHS. It was estimated that 300 million of NHS. Medicines are wasted every year which equates to 100 and 86,300 tons of CO2 emissions. It's difficult to quantify medicines wastage, but it's widely recognized. It's due to ha poor infantry management stock, expiring medication dispensed or drawn up but not given. So the aim was to streamline and reduce the, the stock that we held in theaters was still maintaining access. So we wanted to create a candidate list of low usage drugs that could be taken out of theaters and centralized, ensure and access for all staff. This also had the potential to increase patient safety as well as economic environmental and social benefits. The economic benefits are obviously financial savings and that money that could be better spent within the NHS A reduction in our carbon footprint, health and climate are inextricably linked. So by reducing the environmental impact of medications and its transport, it will have a positive effect on the population with improved air, water and land quality and then social, the drug cups are currently a mess and are managed. It takes staff longer to find medication. It increases stress especially in emergency situations, increases the potential for wrong drug selection, which is the risk to patient safety, increases the risk of drug error, which can have a negative impact on the staff member. So what do we propose to do? So we wanted to define the medications in the theater drug cupboards propose the centralization of low usage drugs model, potential costs and carbon savings and survey staffer opinions on the proposed changes. So SDH is a large teaching hospital spread over two main sites. The Royal Hampshire and the Jet Wing site has 27 theaters and the northern general site has 21 theaters due to time constraints and resource limitations. Data was collected from Jet Wing and a floor theaters at the Royal Hs. We worked on the assumption that we could reduce the low waste usage medication by 50% and calculated cost savings from that. Although there is the potential to make more cuts and more savings. So the potential for a floor theaters and Jess at Wing was a saving of 7017 kg of CO2 emissions with a cost saving of 11,300 lbs. If we extrapolated that trust wide, there's the potential savings of 17,383 kg of CO2 emissions with a a yearly saving of 25 27,989 lbs. So the survey we carried out was at the Jet Wing with the consultant anesthetists. 10 out of the 11 consultant anesthetists that are over at the Jessop's were supportive and could see the benefits of centralizing the stock only to voice some concerns that it could delay emergency treatment or that they will forget where stop was however, any reduction in medication stopped within the anesthetic room and theaters reduces the chaos, variation and risk of medication errors. So what were the challenges? Main challenge really was that we currently do not calculate the cost of the wasted drugs. So there's no way of costing the expired drugs that are wasted throughout theaters. Pharmacy collect the drugs but they do not calculate the cost and often staff dispose of expired drugs in the shop spins the majority of drugs in theaters are IV which tend to have a carbon, a higher carbon footprint as well. Another problem that we we found was stakeholder engagement. So the pharmacy team really unwilling to cooperate or to recognize the extent of the problem. Obviously, we have anxious staff who were worried about the change, delay in emergency care or them not being able to find stock when it was needed and gaining consensus. So, whilst Tim was able to gain consensus at the Jet Wing, as there are 11 consultants, anesthetists that are over there, there's actually 100 and 40 consultant, anesthetists trust wide, so that in itself posed a, a big problem. So Tim presented at the M and M Monthly M and M and um proposed to create a working group which is up and running. He invited everyone to join and obviously be part of the decision making process and uh raise any concerns as well. Sorry, I'm just kind of que a particular problem in theaters is um naloxone and flumazenil. So neither drug are used in theaters because anesthetists would tend to use an anesthetic technique rather than using naloxone or flumazenil. We already keep it centrally and in recovery. However, pharmacy governance have strong views on stocking it in theaters. So currently we stock uh both naloxone and flumazenil in all theaters that expire unopened and unused and are reordered again. So, and good medicines handling um prohibits us from being able to split boxes and only store single drugs rather than a full box. And then obviously, um some of the problems that we've come up against was pharmacy governance telling us what we could remove or couldn't remove from the theaters as well. So just got some examples of um drug cupboards before and after. So during the audit, we found evidence of some unsafe storage, which was quickly rectified. But as you can see, the top drug cupboard is overstocked and overcrowded, which makes it difficult for staff to find drugs when they need it, especially in an emergency. Then following the audit and removal of some of the low use stock and this was at Jessop's where it was easier to um it's only three theaters. Tim had already gained the general consensus of the consultant and anesthetist. So they removed some of the low usage stock. Everything has a place it's clearly labeled, it's streamlined and this is what was taken out of two theaters. Um that is unnecessarily stopped in theaters as well. So I just wanted to say so the, obviously the Green Team competition was a 10 week competition, but it's just really been the start of the work that we're doing over here at, at Sheffield teaching hospitals. It highlighted the problem and we're continuing to make some improvements. So what's happened since the Green Team Competition? We've employed two staff on to common who have protected time each week to work on both sides. And they are also in the theater, drug cupboards. We've identified um pau as a central area on a floor, um theaters. So we're in the early stages of planning you a new purpose built drug room. It's current, our current drug area in recovery at the moment is in a bay in an open busy unit by um planning new papers built drug room. It'll create central storage facilities. It will also create an area that's free from distraction for the nurses that are working in recovery for the preparation of medication. This will improve patient safety and reduce the stress on the team as well. It is also improve the pharmacy tax role by reducing their weight load. They only have one area really to manage rather than multiple theaters for low usage stock. It would reduce chaos. Everything would have a place clearly labeled visual prompt when stock is running low and reduce the risk of drug errors and also reduce waste as well. The money saved by reduced medication stock could be reinvested in our pharmacy service to ensure the sustainability of the project. And moving the current drug area would increase capacity and recovery to support the ongoing plan to increase the Italy and any questions? Thank you so much, Caroline, a great presentation and and great project. Um Yes. Uh The floor is open now for questions, Rosie. Are there any questions in the chat? You can see no questions in the chat yet? Ok. Um Yeah. Do please put questions in the chat while we are waiting? Um I've got a question for you Caroline. Um You talked about the working group. Is it the working group who has decided on which drugs should be um stored in the theater and which ones can be centralized and what has been the uptake of uh the offer of people joining the working group? So it's not. Um So yeah, the working group is to open those discussions about how the, the consultants failed. Um As a team about removing, there's a lot of nervousness about removing drugs from theater just in case. Um So yeah, that that's really where Tim started. But the uptake, I think of the users group is, is not as great as there's a lot of strong opinions but not as many people that have joined the group. I think that's generally um Yeah, but the, the groups there for everyone to have a say and, and Tim presented and asked everyone to be involved in it. So I think they push on if, if nobody has any strong objections. Yeah. And, and do you feel that your project uh looking at uh medicine use in theaters has spread to other areas in the hospital? Looking at uh medicine waste? So it's definitely for us in recovery is, is the whole green team has really. So currently we manage all the medicines in our area, not pharmacy, which has raised a lot of questions and we've been doing a lot of work as a nursing team. We're not trained to manage the medicines. So we've made a lot of improvements in recovery. Obviously, the work that we've been doing with the green team, they're now auditing all the theaters across city at the main site. So there's a lot of scope for, for that to be rolled out over all the theaters. Um, but it's, it's an ongoing, it's a very big piece of work, but an ongoing piece of work that seems to have built in momentum recently. So, yeah. Brilliant, brilliant. Thank you, Caroline. Can I actually ask the other uh, presenters to come on and, and join us on the stage for further questions, Caroline. Are you all right to uns share your slides? Oh, sorry. No, no, that's all right. Um No, no questions yet. Rose in the chat further. Ok. I, I've, I've got a question to Louise if that's, um, all right. I was wondering louise if you had any opposition from the staff of reducing the number of compression stockings. I think we were really lucky. And I, a lot of nursing, a lot of senior nursing staff admitted. Oh, yeah, we just put calf compresses on because that's what we've always done. And yeah, I'm more than happy to change that practice. If you're telling me that it's not appropriate, then that's completely fine. Um, So senior nurses accepted it very well and when the senior nurses accepted, the junior nurses, nurses are always really happy to follow suit. So, no, we didn't. It was, it was really excellent. We'd walk around the unit um a few times a week doing our education and people were excited to see us. We often went around with chocolates, which is probably why they're excited. Um but they're excited to see us because they're excited that we were, we were actually introducing some kind of relevant change to their clinical practice as well, which was really great. So um it it stuck with a lot of them. Um And I think that really shows in the results. But yeah, everyone was really happy to participate and even like doctors and management in ICU were all really on board with it too. No-one really had a problem with it. So, and and apologies if you mentioned it during your presentation. But um was it national guidelines which um gave you indications when you should and you shouldn't use the compression stocks or did you come up with your own guidelines? No, that's a, that's a really good question. I didn't actually touch on that. So, apologies. Um It's, it's actually a hospital specific guideline and that tends to be the case around New South Wales in Australia, um where it's, it's, yeah, hospital based decision making. And so our ICU has their own vte prophylaxis guide. And so we determined whether calf compressors were appropriate or not appropriately used in the purpose of this study based on that guide that already exists. And interestingly enough that guide was I think written maybe 2021. Um and staff, a majority of staff didn't actually know that it existed. So staff were fitting calf compressors for the sake of reducing the risk of VTA but had actual, had no guidelines to base their decision making off essentially. So part of the education was really drawing them to the um idea that we actually had this guideline in place to start with and then made it a little bit easier for them to follow it with that s sort of simple summary table. Um The decision making table that we had Brian. Thank you. Um And sorry. Now I forgot my question. I had another question but um it slipped my mind. Now, are there any current, does the panel have any uh questions for each other? If not, there is a question in the chat Anger. OK. Um Elaine says, um all these projects are so much as much about changing culture, as much as changing clinical practice or if the fantastic presenters can tell us when they realize that other people are getting excited about making these changes. I'm happy to weigh in on, on that one. I think that's a great question. Um I found that delivering the education in our sort of middle phase of our project was when we realized people were actually really engaged and excited about this concept of um reducing the carbon footprint. So staff in our ICU hadn't really had much opportunity to be able to engage in, in and reducing their carbon footprint in their everyday practice. And when they realized, and so we couldn't tell them at the start of our project, why we wanted to reduce what we were doing when we were auditing our use of calf compressors because we didn't want it to change practice. But when we were educating staff about the fact that hey, now we want to reduce our use of calf compressors. They were so excited to hear that it was predominantly because we wanted to reduce our carbon footprint associated with them. And that was the thing that got the most excited, um which I found really interesting because I didn't necessarily think that um a a majority of staff would have that much of a fascination with um environmental sustainability and healthcare. But they all really did, which was really exciting. So, Louise your, your health system in Australia is organized slightly different from the UK. And um I get the impression you're organized regionally how easy it is to spread projects like yours to other regions. No, no, it's slightly easy. Not that easy. I don't know. I think it depends. I think it really depends on the hospitals. Um For those that have a green focus, it's really easy because those hospitals are, are really interested and keen to get on board. And so we've already sort of partnered with a couple of hospitals outside our district, but still sort of within greater Sydney who are really interested in adopting this reducing calf compressors model, which is really exciting. So for them, it's easy because they've got green teams and ICU in particular at those hospitals is really excited about the idea of reducing their, their carbon emissions. Um But we've got other hospitals around New South Wales Health that aren't necessarily focusing on green at the moment. And so I think it's gonna be a little bit harder to target them. Um But I, for us, our project is quite a simple change. It's a, it's, it's not particularly complicated and I don't think staff would necessarily have too many barriers to doing it. So, um we may very well have some pretty decent luck with upscaling, but we'll see how we go all again. Thank you. I can talk about things from a strategy point of view. So strategy and planning manager at Sheffield Teaching Hospital. So um after the green team competition, we wanted to kind of showcase what they've done to raise awareness around um the, the whole organization because we have 18,000 staff. So you know, getting a message out and and changing the cultural shift that's required for 18,000 people is really, really challenging. So we have just done a festival of sustainability in, in June and raising awareness. And I am bringing that office because the comment about changing culture, it absolutely is uh changing culture and hearts and minds. And, but one of the things that we found during the kind of festivals that we've just done is that, you know, yes, we have a sustainability plan, a green policy or whatever. We, we have one and we have themes within that, that match the Sustainable Development goals. Um But nobody really knows what he means and there's no data and there's no metrics to, to, to back it up. And so, you know, within our organization, we only brought a strategic aim of sustainability in, in 2022. So it's very, very much in its infancy. Um And then obviously with COVID and recovery and operational pressures, you know, um a lot of people think that sustainability is something extra that they have to do. And actually, you know, we need to change the narrative and we need to develop a common, common language and common, common jargon of how we're talking about sustainable health care. You know, if you talk about sustainability for people, often think you're an eco warrior. But actually during my conversations and focus groups and, and different webinars that we've done, you know, talking to the staff, you know, in patient facing roles, we talk about, you know what they're doing in their day to day jobs. And I say, well, that's sustainability and that's sustainability and that's sustainability. So it, it, it is trying to change the narrative and it's trying to get able to look at it through a different lens lens and that's the challenge. Um And we can absolutely do that through education awareness with our clinical staff, but we will have to do it with our senior leaders. We have to do it with our board members and, and, you know, they need to start looking at things in a different way and through a different lens because, you know, we've together, we can achieve really great things and we can, you know, it is, it seems like it's a massive um challenge to reach the net zero target the NHS asset. But I think when we start looking at things differently and shape reshaping the narrative, we, we will be able to get there and, but we have to do it as well. So I'm going to get off my soapbox now. Thank you Rachel. And have you got experience already on trying to get the board members um on board. Yeah. And interestingly as part of this festival, we did a um uh we did a climate cafe as we called it with them. And it was with, not necessarily with the kind of trust executive members, but it was with our very senior leaders, our directors of the sustainability delivery group. And we went outside into one of the green spaces um that we have and we had flip charts and we just took one of the, picked one of the themes within the sustainability plan and said, but what does it mean? What does it mean to you? How, how are we gonna develop this? And, and it, it was brilliant, brilliant and they were up and they were, you know, they were with their markers and writing all over and coming up and generating some great ideas, but it generated a whole kind of discussion and, and the whole kind of we're not, we're not doing enough of this and how can we do and how can we support you to do more of this? And so, yeah, um they were uh engaged and they were really enthusiastic, but we, we kind of need to give them the tools of how they, how they can take it forward as well. And that, I suppose is strategy. That's part of my job. Can I, can I just add, I think a lot of my team had had you know, we've known for a long time that we were thrown away medication that was expiring and open and re ordinate and raised our concerns. But no one seemed to take ownership of, of why we were doing that. So I think doing the green team competition has allowed, well, a lot of the team will say, well, that's a waste. And why do we do this? And it's really allowed them now to see that we can, we can actually do something, you know, people are listening and, and there is a way of reducing waste and, and doing little projects like this and, and getting and getting buy in from people outside of the department as well. It's been good for the department. Yeah. Fantastic. And louise, how about you? Was it, is it easy to get senior leadership on board? Have, have you tried? Um Yeah, I think within our hospital, in particular, um our chief executive is a real driving force behind sustainable practice, which is great and so within intensive care itself. Um The green team that we have is made up of some of our sort of more senior um doctors, nurses and some um kind of administrative staff as well. So I think on an ICU level, we've got fantastic support. But from a an overall hospital and district perspective, we've, we've also got really excellent support too. So um I think from that perspective, any changes that we're keen to make are in the green space. Um Sorry, I've got a visit. Um Any, any changes that we're keen to make in the green space in ICU I think are, are completely achievable with the support that we've got. Um which is, which is really exciting and I mean, within our district itself, we've got um funded positions as well um Between one and two days a week where um staff are able to conduct these sustainability projects, which I think is um also a really big nod to the fact that the our hospital district is so supportive of, of getting involved in this and meeting our Net zero targets. So, yeah, thank you. I think um our time is up. Thank you so much to all our presenters and their fantastic project. Thank you, Louise that you've given us some of your holidays as well, very much appreciated. And Rosie that you uh jumped in for uh another Rachel. And of course, thank you, Rachel and Caroline really, really fantastic to have you here. And I think Heather if we've got a 10 minute break now, is that correct? And that is correct? Can I do a slight plug? I put it in the chart because I think there's some ICU people here. So, so watch this space. In fact, Rosie and Ger are helping on a national project and watch this space for more information coming out soon on guidance for in um environmental sustainability in ICU S but the intensive care society in the UK has a page with growing um set of resources. So any ICU folk um check out the chat and um do be in touch with us because we'd love to hear from you. But yeah, it's a great time, a short break and uh welcome address at 52 and the keynote speaker for the second keynote will start at two o'clock. So see you all in the main stage. Thank you, everyone. Well done. Thank you.