Content area
Full text
A Team Approach to the Prevention of Unplanned Postoperative Hypothermia
Jason Bitner, RN; Leana Hilde, RN; Kenneth Hall, RN; Tammy
Duvendack, RN
Hypothermia is a common occurrence in certain types of surgical patients. Although planned
hypothermia may be part of the care plan for some patients undergoing neurological or cardiovascular surgery,1 unplanned postoperative hypothermia frequently is a problem for patients undergoing surgery, particularly for patients undergoing total joint replacement procedures.
The American Society of PeriAnesthesia Nurses defines normothermia as a core temperature ranging between96.8 F and 100.4 F (36 C and 38 C) and hypothermia as a core temperature lower than 96.8 F (36 C).2 Hypothermia may result in longer patient stays in the postanesthesia care unit (PACU) as well as increased risk of intraoperative blood loss, postoperative wound infections, and myocardial ischemia.3 Other complications may include altered drug metabolism and coagulopathies.
Collaboration between clinical staff members (eg, preoperative, orthopedic, intraoperative, PACU) and personnel in the performance improvement (PI) department at Methodist Medical Center of Illinois, Peoria, Ill, (MMCI) was initiated because of concerns about hypothermia in patients undergoing total joint replacement. Anecdotal information from staff members along with an event form re-view indicated a number of reported cases of unplanned hypothermia in this population. This afforded the opportunity to conduct a proactive review of the process in a high-volume, high-risk population. The high volume of procedures, large number of older adult patients, and
large surface area exposed during these procedures put this group at a higher risk for unplanned hypothermia.
The project team hypothesized that use of a preoperative forced-air warming blanket, in addition to intraoperative warming, would improve patient outcomes by decreasing postoperative hypothermia, thus reducing PACU length of stay and patient morbidity. In this project, staff members from PI and clinical nursing applied evidence-based practice to improve patient outcomes.
The PI process is used to study and develop processes for improvements related to patient care. There are several PI models, each with similar principles of continuously improving processes to deliver care. The foundation of the PI process at MMCI is the plan-do-check-act (PDCA) model. This is a never-ending cycle of improvement, which includes planning, implementing the plan, checking the results of the plan, and taking corrective measures or other-wise acting on the...