Evidence-Based Practice Poster Session (Posters #21-#28)
22 - Maintaining Perioperative Normothermia in Adult Surgical Patients
Description: Maintaining Perioperative Normothermia in Adult Surgical PatientsClinical Problem: Perioperative Inadvertent Hypothermia (PIH), a core body temperature below 360C/96.80F, occurs in surgical patients and can cause serious complications (e.g. surgical site infections) and increased mortality rates.
Background: This Evidence Based Practice (EBP) project was implemented in one operating room (OR) of a large 900-bed hospital in Northern Virginia. Previously, only passive warming with warm cotton blankets was used in the preoperative phase of care, while active warming with a Forced Air Warming (FAW) device was used in the OR to maintain perioperative normothermia. This project, based on the evidence aims to promote the addition of active warming preoperatively, using a FAW device and observe changes in perioperative temperatures. Clinical Question: The PICO (Problem, Intervention, Comparison, Outcome) for this EBP project: In adult surgical patients, is prewarming patients in the perioperative phase with active warming (using a Forced Air Warming device) versus passive warming with warm cotton blankets, more effective in maintaining perioperative normothermia?Description of Evidence Based Practice Protocol: A proposal was submitted to and approved by the EBP Fellows Program. A multidisciplinary team was formed, including physicians, perioperative nurses, nurse anesthetists, and a patient representative. A literature search was conducted based on the PICO and literature appraisal and synthesis were completed. Implementation of Evidence Based Practice Protocol: Prewarming and collection of post-implementation data began after staff education was provided and FAW devices were installed in the preoperative bays. Pre-implementation data were retrospectively collected prior to the initiation of prewarming. We used data from 80 patients: 40 prewarmed and 40 non-prewarmed.
Results: Of the 40 non-prewarmed patients, 13 (33%) were normothermic at 30 minutes post anesthesia induction and 15 (38%) at 1 hour. However, of the 40 patients who were prewarmed, it was 12 (30%) at 30 minutes and 21 (53%) at 1 hour. All 80 patients were normothermic upon admission to the preoperative phase and upon arrival to the Post Anesthesia Care Unit.
Conclusion: Literature supports that patients are most vulnerable to redistribution hypothermia in the first hour post induction, and prewarming narrows the temperature gradient between the core and peripheral tissue, reducing the temperature drop that would typically occur from redistribution. Thus, at 1 hour post induction, we noted a higher percentage of normothermic patients in the prewarmed group compared to the non-prewarmed group. There was only a slight difference in the number of normothermic patients in both groups at a half hour post induction.Perioperative Nursing Implications: Maintaining perioperative normothermia through active prewarming may lead to improved patient outcomes.