There are many potentially serious ...

There are many potentially serious chain of cause and effects of inadvertent hypothermia during and after surgery Based in succession recent studies and research, patients whose core temperatures are below 36 [degrees] C (968 [degrees] F) have an increased incidence of pain infection, longer hospital stays, increased surgical bleeding, and increased risk of cardiac events(1) Maintaining normothermia in surgical patients can decrease the risk of morbid cardiac affair by 55%.(2) This maintenance is significant because cardiac morbidity is the leading cause of death during the perioperative period.(3)

Maintaining normothermia must become a priority of perioperative give suck tos because of the serious effects to patients.(4) To date, little has been done to cause to grow standards or guidelines to obviate hypothermia. Surgical services team members at Promina Gwinnett Health scheme Lawrenceville, Ga, who provide care in consequence of two inpatient and two outpatient facilities, believe that perioperative hypothermia can be reduc on using a standardized protocol without the routine use of special equipment (eg forced warm air devices, hyperthermia blankets).

BACKGROUND

Our opportunity to improve patient care began when an anesthesia care provider observ cardiovascular changes in patients who were hypothermic in succession arrival to the inpatient postanesthesia care unit (PACU). After reviewing numerous hints we found that there was no standard definition for hypothermia. Using the hints and our own experience, we defined hypothermia as 355 [degrees] C (96 [degrees] F) or below. Data were scrape togethered on all surgical patients for several month and showed an overall hypothermic rate of 23% Our review of the literature demonstrated hypothermic rates vary from 60% to 90%(5) Although our rate was les than other rates stated in the literature, we believed it was too high and that our patients deserv better care. The surgical area's first continuous quality improvement (CQI) team was formed to address this issue.

THE TEAM BEGINS

The multidisciplinary team comprised professionals who were involved in surgical patient care in succession a day-to-day basis, including OR, perioperative, and PACU nurses; anesthesiologists and pamper anesthetists; and surgeons. Team members focused their efforts onward the improvement opportunity and used a systematic approach to proces improvement. The quality improvement coordinator used just-in-time training to educate team members forward various CQI tools and techniques.

Team members began by the agency of charting the current process from the time the patient go intos the preoperative area until the patient is discharged from the PACU. After the proces was depicted in a flowchart, team members determined that warming IV fluids in the preoperative area might help obstruct patients from becoming hypothermic. After data were gathered and analyzed, team members build that half of the patients had an increase in temperature and half had a decrease in temperature. Team members determined that warming IV fluids in the preoperative area was not necessary. Team members learned the value of using data in decision making rather than relying forward instinct. This discovery also saved the hospital from buying an unnecessary fluid warming cabinet for the preoperative area.

Brainstorming was the nearest step used by team members to identify explanation process variables. These were placed forward a cause and effect (ie, fishbone) diagram (Figure 1) Team members created a check sheet to measure these variables for patients undergoing general, gynecologic, and orthopedic surgical procedures

[Figure 1 ILLUSTRATION OMITTED]

STANDARDIZING CARE

The guide process variables measured by the team were patient's visible form [i]or[/i] frame size, type of procedure and anesthesia, material substance surface area exposed, amount of irrigation fluids used, and warming devices used. No single variable was identified as the cause for hypothermia. The data revealed that the greatest variation in the proces that allowed patients' temperatures to small quantity occurred in the OR. In an effort to stabilize the proces a "mini team" was formed to standardize the care patients receive in the OR. This inferior team comprised OR nurses and members of the anesthesia department who intimateed interest in the hypothermia puzzle and its solution.

After reviewing the data from patients undergoing general surgical operations team members determined that 29% of patients who underwent laparoscopic cholecystectomy operations were hypothermic. Team members researched the literature, charted their have process for keeping patients warm upon a flowchart, and brainstormed general methods for maintaining normothermia. Using this information, team members unraveled one best practice and used a flowchart to demonstrate a standard protocol, which was approved from the team. The protocol involves standardization of latitude temperature, limiting body exposures, and using alone warm irrigation, IV fluids, and inhalation gases (Table 1)

Table 1 THERMOREGULATION PROTOCOL