93 - Hypothermia Protocol "Come in at 36" Our Goal at the Etobicoke General Surgical Program Is to Ensure Your Temperature at a Minimum of 36 *C During Your Surgery. We Will Do This by Monitoring and Warming You to Maintain This Temperature
Description: Our Team Consisted of the Nursing Manager (Christine Paterson) Nursing Educator (Lena Chambelrain) Anesthesia lead (Dr. D Dhanadina) and our NSQIP lead Dr. Rardi Vanheest Osler has made significant gains in the reduction of Surgical Site Infections (SSI) through focusing on appropriate prepping and reduction of the staff entering/leaving the Operating Room. This amongst many initiatives to improve patient outcomes, has led to Osler being ranked by the American College of Surgeons NSQIP program in the top 10% of participating hospitals worldwide for delivering safe, quality surgical care.
The WHO defines Hypothermia as a core temperature below 36oC and is common during and after major surgical procedures lasting more than two hours. The WHO Global Guidelines suggests the use of warming devices in the operating room and during the surgical procedure for patient body warming with the purpose of reducing SSI and other complications associated with surgery. (WHO Global Guidelines for the prevention of surgical site infection)
The current Temperature Monitoring and Warming process includes:Day Surgery • Temperature taken upon arrival (oral)• No patient pre-warming•Each patient gets 1 flannel & 2 cotton gowns OR:•Patient temperature readings are not being monitored up to 70% of the time• Tempature is typically measured with an esophageal or nasopharyngeal probe. Oral and axillary probes are also used. PACU•Temperature is taken upon arrival (mostly oral, axilla also observed)• Policy in place for patients who arrive hypothermic• Discharge policy of >35.5°C
For the adult population with procedures expected to run over 60 minutes, the proposed solution is to replace the current warming solution with the Bair Hugger Gown and Skin Sensor. This will also provide consistent and accurate monitoring pre-op, inter-operatively and post-op as each area utilized various modalities to measure temperature. It will also improve patient comfort and eliminate the use of esphogeal probes.
This approach will:
· Improve Utilization:
o Pre-warming help patient maintain normothermia improving OR utilization
o Shortens the postoperative recovery as patients arrive in PACU warmer
o Maintenance of Normothermia reduces the durations of hospital stays. Hypothermic patient’s duration of stay was 20% longer than normothermic patients.
· Improve Patient Safety
o Maintaining normothermia reduces surgical bleeding and the need for blood products
o Reduces the risk of surgical site infectionIn addition Safer Health Care Now and Canadian Operating Room Leaders recommend: (Safer Healthcare Now, 2014)