217 - Using DMAIC to Improve Core Temperature in Ambulatory Surgery Patients
Description: Poster Title: Using DMAIC to Improve Core Temperature in Ambulatory Surgery Patients Authors: Krystine Watson, BS, RN, Irl Rosner, MD, and Miriam Dowling Schmitt, MS, RN, CPPS, CPHQ Description of team: The team included the nurse manager for the orthopedic ambulatory surgery center, the nurse supervisor, Director of Quality, and anesthesia site chief for the surgery center. Preparation and planning: This project followed the DMAIC format for quality improvement: Define, Measure, Analyze, Improve, and Control. The first step of DMAIC is to define the project by analyzing all available data, talking to stakeholders, and planning additional baseline measurements. The team reviewed data from our anesthesia quality database that showed core temperatures of patients arriving in the PACU were too low. This metric is now reportable to the Centers for Medicare and Medicaid for ambulatory surgery centers.
Assessment: Over the past four years at this ASC, 77.3% of temperatures recorded in the PACU were =36°C. Benchmark is =95%. The team created process diagrams to map potential areas where the ASC was not adhering to best practice and gathered voice of the customer data from patients and staff. The team discovered problem areas and created a fishbone diagram of root causes. Implementation: Core temperature thermometers were purchased to replace forehead temperature strips which provided visual trends, not precise measurements. Standards for temperature monitoring were established for the peri-operative nursing team: all temperatures were measured and recorded in Celsius, normothermia was defined as 36-38°C, and core temperatures were measured both pre-and post-operatively. Nurses initiated warming interventions for patients with a pre-operative temperature <36°C and provided warming devices for all patients with scheduled length of case 60 minutes or longer. A fluid and blanket warmer was purchased for the perioperative area. Nurses were educated on recording temperature upon admission to the PACU and re-measuring if an intervention was necessary. In the OR, locks were placed over thermostats and one person was designated to adjust thermostat. A poster was placed in the breakroom outlining the clinical significance of normothermia. Outcome: In 2017, 86.4% of post-surgical patients demonstrated normothermia within 15 minutes of arrival to PACU. After the interventions, 94.1% of post-surgical patients demonstrated normothermia within 15 minutes of arrival to PACU Implications for perioperative nursing: Hypothermia can be a detrimental clinical outcome of surgical patients. It has been associated with a higher incidence of surgical site infections, cardiac events, increased blood loss, increased duration of anesthetic and neuromuscular blocking agents, extended length of stay in recovery and an increased cost of care. Hypothermia can cause shivering and discomfort having a negative effect on the overall patient experience.