From Ice to Nice: Reducing the incidence of Inadvertent Hypothermia in the perioperative patient
8 April 2016 Last updated:
26 April 2016
From Ice to Nice: Reducing the Incidence of Inadvertent Hypothermia in the Perioperative Patient
CCLHD implemented a number of pre-warming strategies, to reduce the incidence of inadvertent hypothermia in surgical patients.
To increase the rate of patients who achieve a normothermic state prior to induction of anaesthesia by 10% within three months.
- Reduces incidence of inadvertent hypothermia in surgical patients.
- Improves wound healing and recovery time.
- Reduces risk of haemorrhage, myocardial ischaemia and post-operative infections.
- Reduces length of stay in hospital.
- Reduces patient anxiety and increases comfort during their hospital stay.
*Reduces costs associated with managing post-operative complications.
A patient survey undertaken in August 2014 showed that many patients felt cold in the surgical admissions area of Gosford Hospital. Although waiting room temperatures were increased as a result of the feedback, it was determined that further investigations needed to take place, to determine where patients were likely to become cold and how it affected their health outcomes and experience.
It is vitally important that patients having surgery are at an optimal temperature (known as a normothermic state) prior to undergoing an anaesthetic. If the patient has a temperature of less than 36 degrees Celsius, they are at increased risk of a number of complications, including haemorrhage, myocardial ischaemia and post-operative infections. They may also experience lengthy wound healing and recovery time. Managing just one of these post-operative infections can be devastating to the patient and cost the healthcare system around $10,000 per patient.
A retrospective audit conducted in January 2015 showed that 52% of patients arrived in the recovery unit of hospitals in CCLHD with inadvertent hypothermia. A solution was required to reduce the incidence of inadvertent hypothermia and make the patient more comfortable during their hospital stay.
- EasyWarm® active self-warming blankets were provided to patients on arrival to the hospital and 45 minutes prior to surgery. The blanket was placed on their bed during surgery and stayed with the patient during recovery.
- Forced-air warming was initiated in theatre once patients were positioned for surgery.
- Bair Hugger temperature management systems and warm fluids were implemented if the patient’s temperature was below 36 degrees Celsius on admission to the hospital.
- After consultation with the manufacturer, information brochures on self-warming blankets were given to patients who were participating in the trial. This provided valuable information on the blanket and helped them understand the aims of the project.
- Patients were also educated on the importance of keeping warm, during pre-operative phone calls.
- The manufacturer provided face-to-face education sessions on pre-warming strategies to ward and theatre staff, as well as posters and user guides for patients.
- Pre-warming strategies to maintain normothermia prior to surgery were incorporated in management policies at CCLHD.
- Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.
- January 2015 to February 2016
- Operating theatres, Gosford Hospital
- Operating theatres and Surgical Admissions Centre, Wyong Hospital
- Clinical Leadership Program, Clinical Excellence Commission
- An audit conducted prior to the project showed that 52% of patients arrived in the recovery unit following surgery with inadvertent hypothermia.
- A second audit conducted in July 2015 found that 65% of patients had one or more hypothermic events during their surgical intervention and that 15% of patients arrived at the hospital in a hypothermic state.
- Preliminary results following project implementation showed a reduction in hypothermia from 65% in July 2015 to 35% in February 2016.
- The number of patients arriving in the anaesthetic bay with hypothermia reduced from 15% in July 2015 to 1% in January 2016, in Gosford operating theatres alone. As of April 2016, Wyong data is still being collected.
- It is extremely important that communication is thorough and extensive.
- Data speaks louder than words. We found that we got a better response from sharing data, than simply stating there may be an issue.
- Using champions to spread the word and support the project made the process easier.
- National Institute for Health and Care Excellence (NICE). Hypothermia: prevention and management in adults having surgery. United Kingdom: NICE; 2008.
- Institute for Healthcare Improvement (IHI). Maintain perioperative normothermia in surgical patients. Cambridge: IHI; 2016.
- Mölnlycke Health Care, EasyWarm® active self-warming blankets suppliers.
Nurse Manager, Perioperative Services, Gosford Hospital
Central Coast Local Health District
Phone: 02 4320 3471
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