The management and prevention of inadvertent peri operative hypothermia (IPH)

Abstract

Objectives This evidence based quality improvement project sought to measure current practice during the peri operative journey against recommendations from the evidence-based literature and guidelines, followed by the implementation of key strategies to reduce and manage IPH. Methods This project utilised a process of audit and feedback to measure current practice, implement recommended strategies and assess practice change in line with the evidence. Audits utilised eighteen criteria developed from three systematic reviews and four clinical guidelines. The inclusion criteria were adult patients over 18 years of age, undergoing general, local or regional anaesthesia. Patients less than 18 years of age, undergoing local anaesthesia only or sedation, or placed in induced hypothermia were excluded, as were any patients bypassing PACU after surgery. Sample size for the audits was 73 charts pre-implementation and 72 charts post-implementation. Strategies implemented to change practice included - consistent measurement of temperature, pre-warming prior to surgery and postoperative warming. Additional strategies included patient information and the maintenance of normothermia prior to surgery. Results Results were disseminated to staff after each audit via email, paper and oral presentation. Champions and opinion leaders were essential to drive change. Prior to the implementation of strategies the opportunity was given for staff to give feedback on the proposed changes. Post-implementation there was an 8% reduction in the number of hypothermic patients on arrival to PACU. Temperature measurement was introduced in the Pre Op Holding Bay. An increase in discharge temperature from 35.5°C to 36°C was adhered to, thereby increasing the number of normothermic patients returning to ward areas. Discussion The project has been successful in increasing an awareness of IPH as a problem that needs to be prevented and managed. Difficulties were experienced in the introduction of pre-warming and with implementing changes within such a complex work area with a high number of multidisciplinary working groups. Issues with the reliability and accuracy of temperature measurement devices were highlighted after the second audit and have ensured greater scrutiny of the measurement devices used in Operating Theatres. Conclusion Management of IPH has improved in line with best practice guidelines within this area of practice. However work is ongoing and, in particular, consideration is needed regarding temperature measurement devices and techniques to ensure consistency and accuracy. Further audits will be required in the future to ensure this practice is sustained.