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DNP Innovation in the OR

Jillian Guzzardo

Jillian Guzzardo '19 DNP, CRNA focuses closely on her patients every day in the OR in Philadelphia where she practices as a certified registered nurse anesthetist.

In pursuit of her Doctor of Nursing Practice degree, she also noted the following:

  • The U.S. Health sector contributes greatly to climate change through the release of greenhouse gases (GHG) and the advancement of global warming
  • Anesthesia delivery plays a critical role – as all inhaled anesthetic agents are recognized GHGs and contribute to global warming
  • The rate of flow of fresh gases (air, oxygen, and nitrous oxide) delivered during general anesthesia is the primary determinant of inhaled anesthetic use
  • Lowering the rate of fresh gas flow (FGF) reduces the amount of inhaled anesthetic agent released into the environment
  • Current evidence supports adoption of FGF rates less than or equal to 1 Liter/minute to substantially reduce environmental GHG emissions.

For her DNP scholarly project, "Reducing Inhaled Anesthetic Waste Through Utilization of Low Fresh Gas Flow," she wanted to facilitate a change in current practice to reduce inhaled anesthetic waste through the use of low fresh gas flow (less than or equal to 1 L/min).

In implementing her innovative idea, she created an educational intervention for Nurse Anesthetists, including a presentation on healthcare contribution to climate change and related public health effects, a demonstration of inhalational anesthetics as greenhouse gases and their contribution to global warming, and an explanation of the need and feasibility of low FGF technique, recommendations for practice (FGF less than 1L/min during general anesthesia cases) and considerations for safety.

Continued conversations, education and meetings engaged her colleagues with a result that lowered FGF rates reduced inhaled anesthetic use and purchasing costs considerably and the overall reduction in inhaled anesthetic use led to measurable decrease in greenhouse gas emissions.

As Dr. Guzzardo notes, "CRNAs are well suited to evaluate current evidence, facilitate change, and shape improvements in patient care and CRNA-driven quality improvement initiatives can shape the future of healthcare delivery and promote best practice."