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Manitoba Pharmacist Leads Green Anesthesia Revolution to Fight Climate Crisis

Photo of Rizwan Ahmed

In the heart of Southern Manitoba, Rizwan Ahmed, a Pharmacist and the Director of Pharmacy for Southern Health-Santé Sud, is spearheading an initiative aimed at transforming how operating rooms think about anesthesia- not just in terms of patient care but also environmental impact. His mission is to eliminate the use of desflurane, a commonly used anesthetic gas with a disproportionately large impact on the climate crisis.

What is Desflurane and Why Does it Matter?

Desflurane has long been a common choice for maintaining general anesthesia during surgeries. As an inhaled anesthetic, administered as a gas, its offers rapid onset and recovery times. However, what many may not realize is that desflurane is also a potent greenhouse gas. It lingers in the atmosphere for over a decade and has a global warming potential (GWP) more than 2,500 times that of carbon dioxide.

“One hour of surgery using desflurane is equivalent to driving a car for 320 kilometers. That would be like driving all the way from Winnipeg to Dauphin,” Ahmed explains. “In a busy hospital, that adds up quickly.”

Motivated by growing evidence of healthcare’s contribution to climate change- estimated at nearly 5% of Canada’s total emissions- Ahmed launched his project “Putting Desflurane to Bed”. The goal is simple: phase out the use of desflurane from Southern Health-Santé Sud’s regional system to promote safer, greener alternatives that provide the same level of patient care without the environmental toll.

Fortunately, the science is on his side. Other anesthetics like sevoflurane and isoflurane, while still greenhouse gases, have far lower GWPs — up to 20 times less harmful than desflurane. Additionally, total intravenous anesthesia (TIVA), which relies on IV-administered agents rather than inhaled gases, offers another safe and effective alternative with negligible climate impact. Ahmed is working with hospital pharmacists and surgical departments to encourage use of these alternatives.

“Sevoflurane works beautifully for most procedures,” says Ahmed. “It’s clinically equivalent for the vast majority of surgeries. The only thing we’ve been slow to adapt is our mindset.”

The project is part of a broader movement in Canada and beyond. Countries like the U.K. and Sweden have already banned desflurane for routine use, with several Canadian provinces are beginning to follow suit. Ahmed envisions his project being implemented across the province, positioning Manitoba as a model for how local action in healthcare can have a global impact.

A Deep Connection to Nature

Ahmed’s passion for sustainable healthcare is rooted in a profound respect for nature cultivated from his earliest years. Growing up in Pakistan, he experienced firsthand the vital role nature plays in health and healing. The traditional Pakistani practices and natural remedies fostered a lifelong appreciation for the environment’s impact on well-being.

“When I moved to Manitoba, I found new inspiration in the Indigenous cultures here,” Ahmed shares. “Their holistic view of health—where humans, land, and spirit are interconnected—deepened my commitment to environmental stewardship in medicine.”

This perspective drives Ahmed’s work to make Manitoba’s health system more environmentally responsible, bridging scientific innovation with cultural wisdom.

“Climate change is a health emergency, and healthcare can’t be part of the problem. As doctors, we make every decision for our patients with their safety and well-being in mind. We should do the same for Mother Nature, we should think of her as our patient as well,” he says.

“We have the tools to change — and the responsibility to use them. We can’t move mountains alone, but if we work together, we can move one rock a day and make a big impact for the world we live in.”

Call for Content – Choosing Wisely Canada National Meeting 2025

Call for Content - Choosing Wisely Canada National Conference

Exciting news! We are thrilled to share that the next Choosing Wisely Canada National Meeting will be in Winnipeg in May 2025! This is your chance to showcase the amazing initiatives and innovative care approaches you have implemented in the Manitoba health system to reduce low value tests, treatments and procedures. Ready to shine? Submit your abstract or presentation pitch now!

Call for Content: Choosing Wisely Canada’s National Meeting – Choosing Wisely Canada

Dr. Sokoro Awarded at National Conference

Dr. Sokoro with his CWC Award in 2024

Choosing Wisely Manitoba is proud to announce, Dr. AbdulRazaq Sokoro, PhD, FCACB, FADLM. Chief Operating Officer, Provincial Diagnostic Services, Shared Health, was awarded the Clinical Excellence in Choosing Wisely Award at the national Choosing Wisely Conference held in Montreal on April 15, 2024. This award, recognizes a clinician (physician, nursing, pharmacist, allied health) who has exhibited exceptional leadership and commitment to resource stewardship within their clinical practice, with a dedication to reducing unnecessary tests and treatments while enhancing patient care.

Dr. Sokoro has contributed to Manitoba’s health system for 14 years serving in a variety of roles including Shared Health’s Executive Director of Provincial Laboratory Operations, and Associate Head of the Department of Pathology at the University of Manitoba’s Max Rady College of Medicine

As noted in his nomination, Dr. Sokoro has supported a large number of initiatives in Manitoba, which have resulted in the following changes and improvements:

  • Streamlined and sustainably reduced Vitamin D testing in Manitoba by 90%
  • Embedded Choosing Wisely/ Resource Stewardship into curriculum with International Medical Graduate students and Post Graduate Medical Student Education
  • Championed the development and implementation of Manitoba Endocrine Guidelines including guidance on screening and adding reflex testing for Free T3 and T4
  • Introduced Provincial guidelines to reduce FOB testing of inpatients by 74%
  • Supported provincial guidelines for hospital labs to require a positive urinalysis prior to a urine culture, to encourage appropriate testing.

Dr. Sokoro holds a BSc (Hons) in Biochemistry and Zoology from Egerton University in Njoro, Kenya as well as a PhD in Toxicology from the University of Saskatchewan and a post-doctoral residency in Clinical Biochemistry from the Max Rady College of Medicine at the University of Manitoba. He is a fellow of the Canadian Academy of Clinical Biochemistry, Canada and the Association for Diagnostics and Laboratory Medicine in the United States.

His recent professional accomplishments beyond Choosing Wisely range from the standardization of quality oversight of point of care testing in a partnership with First Nations & Inuit Health Branch, development of a red blood cell utilization/transfusion strategy that brought Manitoba in line with the rest of Canada, to ongoing efforts to train, recruit and retain laboratory staff. Dr. Sokoro’s collaborative approach and passionate advocacy for communities, partner organizations and staff are valued assets as part of any team he is part of.

Congratulations Dr. Sokoro, your efforts and perseverance have assisted Manitoba’s current and future health providers to choose more wisely.

Manitoba Hospitals Achieve Province-Wide Using Blood Wisely Hospital Designation Status

Hospitals in Manitoba have reached a major milestone in their blood stewardship efforts. Every hospital that performs transfusions in the province has achieved the Using Blood Wisely Hospital designation status.

“We undertook this work to ensure Manitoba’s blood products were being used as efficiently and effectively as possible,” explains Dr. Charles Musuka, Haematopathologist and Medical Director for Transfusion Medicine at Diagnostic Services, Shared Health.

Manitoba was one of the highest users of blood products nationally with a rapidly growing rate of use each year. Blood products such as red cells and plasma are a critical resource used in treating and recovering many Manitobans.

Largely starting in 2021, new provincial practices and guidelines were implemented to help bring Manitoba into alignment with national rates of use. These guidelines ensure blood product use is prioritized using best practices to impact patient care the most. With appropriate clinical oversight, the needs of patients continue to be met while the supply is more efficiently managed to allow for a stabilized and standardized use of blood products across the province.

“Achieving these designations is a testament to the incredible work and dedication of health-care providers and administrators across the province,” says Dr. Musuka. “Despite incredible pressures, they have exemplified an unwavering commitment to delivering high-quality care.”

This provincial accomplishment has now been officially acknowledged as the Interlake-Eastern Regional Health Authority recently joined other Manitoba regions and hospitals in receiving the Using Blood Wisely designation.

“We are excited to be part of this important work happening across the province and proud of our region for achieving its Using Blood Wisely designation,” says to Katie Hibbs, Director Health Services – Acute, Selkirk Regional Health Centre.

Using Blood Wisely, launched by Choosing Wisely Canada and Canadian Blood Services, recognizes hospitals that have made significant achievements in meeting national appropriateness benchmarks for reducing inappropriate red blood cell transfusions. The inappropriate use of blood transfusions can significantly strain Canada’s blood supply and increase the risk of potential harm to patients.

In Manitoba, the work included a collaborative transfusion stewardship project called Appropriate Inpatient Red Blood Cell Utilization in Manitoba. This provincial clinical practice change implemented a new set of guidelines that optimizes laboratory and clinical processes to assess the appropriateness of each unit transfused in the inpatient setting. Results have included sustained reductions in inappropriate red blood cell transfusions, leading to improved patient outcomes and reduced risks associated with blood transfusions.

This initiative demonstrates a true provincial effort in implementing practices that benefit the system, health-care providers and patients. This milestone not only highlights leadership in promoting best practices but also serves as a reminder of the critical importance of blood products and the need to carefully manage this life-saving health-care resource.

La désignation Transfuser avec soin pour tous les hôpitaux du Manitoba

Les hôpitaux du Manitoba ont franchi une étape importante dans leurs efforts de gestion du sang. Tous les hôpitaux qui pratiquent des transfusions dans la province ont obtenu la désignation Transfuser avec soin.

« Nous avons lancé cette initiative pour nous assurer que les produits sanguins du Manitoba sont utilisés le plus efficacement possible », explique le Dr Charles Musuka, hématopathologiste et directeur médical de la médecine transfusionnelle, Services de diagnostic, Soins communs.

À l’échelle nationale, le Manitoba était l’un des plus importants utilisateurs de produits sanguins, avec un taux d’utilisation en augmentation rapide chaque année. Les produits sanguins, comme les globules rouges et le plasma, sont une ressource essentielle pour traiter la population manitobaine.

Depuis 2021, de nouvelles pratiques et lignes directrices provinciales ont été mises en œuvre pour que le Manitoba harmonise son taux d’utilisation avec celui du pays. Ces lignes directrices visent une utilisation optimale des produits sanguins en s’appuyant sur des pratiques exemplaires qui permettent d’améliorer les soins aux patients. Une surveillance clinique appropriée permet de répondre aux besoins des patients tout en assurant une gestion efficace des produits sanguins ainsi qu’une utilisation connexe uniforme et normalisée dans l’ensemble de la province.

« L’obtention de cette désignation témoigne du travail et du dévouement incroyables des administrateurs et des fournisseurs de soins de santé de la province », déclare le Dr Musuka. « Malgré les conditions difficiles, ils ont fait preuve d’un engagement inébranlable à fournir des soins de qualité. »

Cette initiative provinciale est maintenant officiellement reconnue, et l’Office régional de la santé d’Entre-les-Lacs et de l’Est s’est récemment joint à d’autres régions et hôpitaux du Manitoba pour obtenir la désignation Transfuser avec soin.

« Nous sommes heureux de participer à cette initiative provinciale importante, et nous sommes fiers que notre région ait obtenu la désignation Transfuser avec soin », affirme Katie Hibbs, directrice des services de santé – Soins de courte durée, Centre de santé régional de Selkirk.

Lancé par Choisir avec soin et la Société canadienne du sang, le programme Transfuser avec soin reconnaît les hôpitaux qui ont réalisé des progrès notables pour ce qui est du respect des critères de référence nationaux visant à réduire le nombre de transfusions inappropriées de culots globulaires. Les transfusions sanguines inappropriées diminuent considérablement les réserves de sang du Canada, et augmentent le risque de préjudice pour les patients.

Au Manitoba, l’initiative comprend un projet collaboratif de gestion des transfusions intitulé Utilisation appropriée des transfusions de culots globulaires chez les patients hospitalisés au Manitoba. De nouvelles lignes directrices visant l’optimisation des processus de laboratoire et cliniques afin d’évaluer la pertinence de chaque unité transfusée à un patient hospitalisé ont été mises en œuvre dans le cadre de la modification des pratiques cliniques à l’échelle de la province. Ainsi a-t-on pu observer une réduction durable du nombre de transfusions inappropriées de culots globulaires, une amélioration des résultats pour les patients et une réduction des risques liés aux transfusions sanguines.

Cette initiative témoigne d’un véritable engagement provincial dans la mise en œuvre de pratiques bénéfiques pour le système, les fournisseurs de soins de santé et les patients. Non seulement ce jalon souligne-t-il l’importance de promouvoir les pratiques exemplaires, mais il rappelle également le caractère essentiel des produits sanguins et la nécessité de gérer avec soin cette ressource médicale qui permet de sauver des vies.

Choosing Wisely Talks – April

Addressing Surgical backlogs in Canada

When: April 19 at 12 PM ET 
Register here

Surgical backlogs are causing significant pressures in provinces across the country, exacerbated by successive waves of the pandemic and shortages in health human resources. What is the role of reducing overuse in addressing backlogs and how can we better support Canadians in making informed decisions about their surgical care?

Join Choosing Wisely Talks on April 19 at 12 p.m. ET to discuss the current state of surgical backlogs in Canada. Experts will discuss the role of shared decision-making, system changes, and how we can work together to improve access to timely and high-quality surgical care.

Speakers

Dr. Logan Trenaman, Scientist, Centre for Health Evaluation and Outcome Sciences, University of British Columbia

Dr. Sacha Bhatia, Population Health and Value Based Care Executive, Ontario Health

Choosing Wisely Talks – March

Pharmacists’ Expanded Scope — and What it Means for Appropriate Prescribing

When: March 22 at 12 PM ET 
Register: https://choosingwiselycanada.zoom.us/meeting/register/tZYod-mvpjssH9T-yQ0AbAmPqM38BULkJDMB

In several provinces, the scope of pharmacist prescribing has expanded, enabling them to assess and prescribe treatments for common syndromes. With other provinces and territories expected to adopt similar approaches, how do we support pharmacists, physicians, and other healthcare professionals in promoting resource stewardship and appropriate prescribing practices?

On March 22 at 12 p.m. ET, Choosing Wisely Talks will discuss the widened scope of practice for pharmacists. Experts will discuss recent changes and future thinking around interprofessional collaboration in patient care.

Speakers

Danielle Paes, Chief Pharmacist Officer, Canadian Pharmacists Association (CPhA)

Shelita Dattani, Vice President, Neighbourhood Pharmacy Association of Canada

Discussant

Janet Reynolds, Family Physician, Choosing Wisely Canada Primary Care Co-Lead

National Meeting 2023 – Call for Abstracts

Choosing Wisely Canada is now accepting abstracts to be featured at Choosing Wisely Canada’s National Meeting, on May 11 and May 12, 2023.

Showcase your Choosing Wisely Canada initiatives and innovative approaches based on the following themes:

  • Quality Improvement/Implementation (e.g. interventions, health policy, interprofessional collaboration, deprescribing)
  • Measurement and Evaluation (e.g. administrative data, trends in low-value care, impact of intervention on low-value care)
  • Medical Education
  • Patient Engagement
  • Environmental Sustainability (reducing low-value care can avoid harm to patients and the planet)
  • Appropriate Prescribing

Abstracts will be accepted in English and French. Relevant abstracts will be published in a digital abstract book and considered for in-person presentations in concurrent breakout sessions.

Important Dates:

  • Abstract submissions will be accepted until January 13, 2023.
  • Abstracts considered for in-person presentations will be notified by February 6, 2023.
  • National Meeting: May 11 & May 12, 2023.

If you are submitting an abstract from Manitoba, please email [email protected].

Full details

Using Labs Wisely During Global Blood Tube and Other Resource Shortages

COVID-19 has put an extraordinary strain on laboratory medicine in Canada due to critical shortages in blood tubes, devices, and lab staffing.

To address the need to conserve tubes and critical laboratory resources, the Canadian Society of Clinical Chemists and the Canadian Association of Medical Biochemists have assembled two sets of relevant Choosing Wisely Canada recommendations—for hospitals and primary care.

How you can get involved:

National Meeting 2022 – Call for Abstracts

Choosing Wisely Canada is now accepting abstracts to be featured virtually at Choosing Wisely Canada’s National Meeting, on May 25 and May 26, 2022.

Showcase your Choosing Wisely Canada initiatives and innovative approaches based on the following themes:

  • Quality Improvement/Implementation (e.g. interventions, health policy, interprofessional collaboration, deprescribing)
  • Measurement and Evaluation (e.g. administrative data, trends in low-value care, impact of intervention on low-value care)
  • Medical Education
  • Patient Engagement

Abstracts will be accepted in English and French. Relevant abstracts will be published in a digital abstract book and considered for online presentations in concurrent breakout sessions.

Important Dates:

  • Abstract submissions will be accepted until February 18, 2022 (extended from January 28, 2022).
  • Abstracts considered for online presentations will be notified by February 16, 2022.
  • National Meeting: May 25 & May 26, 2022.

Full details

When Every Drop Counts – Using Blood Wisely Designations

Southern Health-Santé Sud has been named the first health region in Canada to receive national Using Blood Wisely Designation. This signifies that each transfusing facility within Southern Health-Santé Sud has met or exceeded the national benchmark of appropriate red blood cell use in Canada.

As a vital and lifesaving resource, protecting Canada’s blood supply has never been more important due to the urgent care needs and constraints related to COVID-19. That’s why over 120 hospitals are participating in the Using Blood Wisely campaign, a national initiative to reduce inappropriate red blood cell transfusions. This campaign challenges hospitals to audit their inpatient red blood cell transfusions to see how they compare to national appropriateness benchmarks.

Southern Health-Santé Sud is a designated bilingual Regional Health Authority located in southern Manitoba, covering an area over 27 025 square kilometers wherein vibrant communities thrive including: 20 Rural Municipalities, 7 Municipalities, 4 cities, 4 towns, 1 village and 1 unorganized territory; 7 First Nation communities and many other cultures and communities including Métis, Hutterite, Francophone and Mennonite. They serve over 207 855 residents, the fastest growing population in Manitoba.

“These designations are an exciting achievement for all levels of health care, from leadership to front line staff,” says Dr. Charles Musuka, Medical Director, Transfusion Medicine, Shared Health. “We are so grateful for the hard work and dedication of all clinical and laboratory staff in Manitoba. This is a testament to their commitment to providing the best possible care for patients and best practices in Manitoba.”

With support from the Shared Health Transfusion Medicine Program, Best Blood Manitoba, and Choosing Wisely Manitoba, the hospitals and facilities within Southern Health-Santé Sud teamed up to implement the transfusion stewardship project – Appropriate Inpatient Red Blood Cell Utilization in Manitoba. This provincial clinical practice change implemented a new set of guidelines that optimizes laboratory and clinical processes to assess the appropriateness of each unit transfused in the inpatient setting.

Nurse educators, clinical educators, physicians, leaders and other staff from across Southern Health-Santé Sud also took part in a key step of the Appropriate Red Blood Cell Utilization project. Prior to the provincial roll out of the project, these individuals granted the Transfusion Stewardship team their time and expertise by joining in on a workshop to provide feedback on the guidelines. This additional support provided by the region was an influential aspect in the success of this important change for our province.

“The Southern Health-Santé Sud region has been an important partner in this project,” said Petr Kresta, Chief Operating Officer, Diagnostic Services, Shared Health. “Staff and clinicians from the region came together to provide important assistance to our Transfusion Medicine department by reviewing and testing changes to optimize this process for all of Manitoba. Being named the first region in Canada to receive the Using Blood Wisely designation is an exciting testament to their commitment to transfusion stewardship.”

When every drop counts, it takes a concerted effort to safeguard Canada’s blood supply. Choosing Wisely Canada and Canadian Blood Services would like to thank participating hospitals for their pursuit of best practices in transfusion medicine and collective efforts to deliver safe, quality, and appropriate care.