Entonox safety in the workplace, administration equipment, scavenging and ventilation systems, occupational exposure levels.

Entonox is a medical gas 50% Oxygen 50% Nitrous Oxide – used as a form of inhalation pain relief in many medical settings, in Obstetrics it is used in Labour.

Nitrous Oxide is classed as a hazardous substance, which if exposure to such substances is not properly controlled may cause ill health in a number of ways (HSE EH405/2005 workplace exposure limits 2020 edition).

Download HSE guidance

Download BOC essential guide to entonox 

As elected RCM health and safety representatives you can legally undertake an inspection of your workplace. You will need to give reasonable notice to your employer (if it has not been inspected within last three months), however if an issue has arisen urgently, please discuss with the employer, that you intend to do this.

You can perform an inspection individually or take another RCM activist with you, your manager can accompany you if they wish to do so.

As part of the inspection of areas where Entonox is administered you should contact the estates officer and HB/Trust safety lead ask for written response and evidence to answer the following questions:

• What scavenging /ventilation system the unit has
• What are the rate of air changes per hour and how it works.
• Are these compliant with manufactures recommendations and the DOH recommendations?
• How often are the seals checked on all tubing and appliances are these seals changed regularly – is this compliant with manufacturer and DOH recommendations?
• When was the last inspection what was the outcome
• Evidence of maintenance and regular inspections for damage to equipment required to administer and work with Entonox safely.
• Do you have a clear policy for administration of Entonox
• What training do staff receive regarding the administration of Entonox including storage, transportation and personal safety.

There should be evidence that is happening. Once you have completed your inspection you must report any issues arising.

The first thing you should do is submit an incident report and you should escalate this immediately, verbally and in writing to the employer, area manager and the employer’s safety officer and ensure this is raised at the employer safety meetings, to make sure it is followed up.

It is always worth keeping an eye on it yourself and checking what progress is being made. As an elected H&S rep for a recognised TU you should be part of the safety meetings and any consultations.

RCM H&S reps can work with the safety officer and, if necessary, a representative from the Estates department to perform a COSHH risk assessment.

Inform the staff side chair and work collectively with other Trade Unions with members in the affected areas.