A team approach to the prevention of unplanned postoperative hypothermia

AORN Journal,  May, 2007  by Jason Bitner,  Leana Hilde,  Kenneth Hall,  Tammy Duvendack

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* Hypothermia was found to be related to an increased need for postoperative observation in patients 60 years of age or younger; in patients undergoing general anesthesia; and in patients undergoing general, thoracic, or abdominal surgery. (3)

* Harper stated that "the hypothermic group remained, on average, 2.6 days longer in the hospital" than a normothermic group. (12(p72l))

* Sladen noted that during surgery, a patient also can become hypothermic by conductive heat loss through direct transfer of body heat to the OR bed, cold irrigation fluids, and cold blood and IV fluids. (13)

* Fiedler's study revealed that "most anesthetists are aware that patients can lose a great amount of heat in the operating room. Efforts to maintain heat should begin in the holding area." (14(p485))

Patients at high risk for hypothermia include older adults, patients undergoing lengthy surgical procedures, and patients with large surgical incisions, low body mass index, or thyroid disorders. Adverse outcomes included increased wound infection, impaired cardiac function, coagulopathy, and increased morbidity and mortality.

THE PROJECT

The purpose of this project was to compare the postoperative temperature of patients who underwent total joint arthroplasty procedures but who did not receive any form of preoperative warming with the postoperative temperatures of patients undergoing the same procedures after the institution of a policy of warming patients with a preoperative forced-air warming blanket. Baseline data were collected for the patient population in June 2004. The independent variable in this project was the application of a forced-air warming blanket preoperatively or not applying a forced-air warming blanket preoperatively. The dependent variable was the postoperative temperature of the patient, taken orally, axillarily, or rectally. A nominal scale measurement (ie, hypothermic, normothermic) was used to measure the dependent variable. The control group consisted of the baseline patient population treated according to current practice and who did not have forced-air warming blankets applied preoperatively* The treatment group had upper body, forced-air warming blankets applied preoperatively at a setting that would maintain patient comfort and normothermia. Both groups received the same intraoperative care. A data collection tool was used to record the relevant information (Figure 1). Data were excluded if the collection tool was not completed.

PI PRINCIPLES

One of the principles of the PI process at MMCI is the PDCA model of continuous improvement. The method employed by MMCI incorporates the three steps of

* assessment,

* innovation, and

* results.

This is referred to as the Methodist Centered on 3 (MC3) method, which is based on the "define, measure, analyze, improve, and control" (DMAIC) model and can be related to other common PI process models (Table 1). The MC3 model centers around solving problems, determining the root cause of problems, formulating ideas that would result in improvement, testing those improvements, maintaining the improvements, and emphasizing a rapid cycle of change.