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Aims and Objectives There is a widely-held dogma among ED staff all ED patients require iv access. I also learned that the emissions impact of a cannula is far bigger than that of venepuncture. We estimated that a 66g cannula with iv extension would produce 1.086kg CO2e, far greater than venepuncture. Could this be a simple intervention to reduce CO2e and single-use plastic consumption?Method and Design We used QI methodology, employing several cycles of change % patients cannulated% cannulas unused. Interventions included: Messaging: Continuous messaging which included performance data, cannula indications (see below) and CO23 impact of cannulas using analogies such as long-distance aeroplane journeysBranding: A tagline (Cut The Cannula), with a Ghostbusters-style logo which was turned into lanyard badgesDirect engagement: We relied on old-fashioned reminders and engagement with colleaguesCannulation guidelines: Based on consultant consensus, we created traffic light-based criteria for cannulationPhlebotomy request sheet: We removed the word ‘cannula’ from the sheet, and staff are now required to write ‘cannula’ as a special requestEmpowering the phlebotomists: to challenge Band nursing/medical staff when an inappropriate cannula was requested Cannula pack stickers: We stuck several of these regularly on random cannula packs, to encourage staff to think twice before they site a cannulaResults and Conclusion Baseline measurement: 75% of ED Majors patients were cannulated, and 37% had unused cannulas We also interviewed patients: 68% had a negative view of their cannula whether or not they were receiving iv medication First cycle: % cannulas inserted and % cannulas unused fell to 61% and 27% respectively. This equated to a potential annual reduction of around 19,000 kgCO2e and cost saving of around £95,000. Over the next 4 years there has been an overall improvement in both outcome measures. Conclusion: QI methodology can be used to improved environmental sustainability of ED activity.