341 - Keep Warm, Keep Well – Maintaining Normothermia from Pre-op to PACU/PICU
Description of the Team: Pre-Op & Intraoperative RNs, Orthopedic Surgeons, Anesthesiologists, Physician Assistants , Educators, patients and families. Background and
Purpose: To ensure that we are prepared to care for our orthopedic patients, we reviewed our practices and processes. Evidence tells us that actively pre-warming helps to prevent hypothermia (AORN Guidelines 2019). This evidence led us to consider pre-warming a high risk population of patients. Adverse reactions to hypothermia may include wound infection, pour wound healing, increased blood loss, need for blood transfusion, decreased renal function and prolonged hospitalization. Assessment: Historically, we have found it difficult to maintain normothermia in neuromuscular (NM) spinal fusion patients. Target population was any NM spinal fusion patient within the orthopedic service whose Surgeon volunteered to participate in the trial. For scheduling purposes, neuromuscular was defined using CPT code 22848 Pelvic Fixation (attachment caudal end of instrumentation to pelvic bony structures). Preparation and Planning: After engaging the Surgeons and Anesthesiologists through open discussions, we worked with our vendor to order gowns. One box (20 gowns) and three warming units were donated for the trial. An In-service for the Pre-Operative and Intraoperative RN staff occurred prior to starting the trial date of January 1, 2019. Implementation: 1. Pre-Op RN places under body warming blanket on stretcher 2. Patient placed on stretcher 3. Warming gown placed on patient 4. Warming unit attached to gown, turned on high by Pre-Op RN 5. When patient is transported to OR, warming unit is detached and stays in Pre-Op 6. OR RN transports patient to OR, attaches and turns on under body warming blanket. This allows continued warming for induction, intubation, IV starts, central line placement, urinary catheter insertions, placement of pressure site padding, SSEP/MMEP monitoring needles and discs 7.Lower body warming blanket used during procedure Outcome and Benefits: 100% of Surgeons who participated in trial agreed to move forward with permanent implementation. All Anesthesiologists who answered the feedback e-mail were in favor. Pre-OP staff found the process simple and easy. Families were agreeable to education. Minimal cost to hospital - $8.23/gown. Nursing Implications: After successful trial, an algorithm was developed. Medical history, patients BMI and length of surgery are the criteria for the algorithm. During the development of the algorithm and after discussing the trial with team members, it was suggested we include the type of orthopedic procedure. This would then encompass the entire orthopedic service and the process improvement would reach a larger volume of our patients. We have a very high volume of patients with neuromuscular disorders, surgeries lasting longer than two hours, BMI’s <25, and/or the patient being exposed after induction for multiple tasks being performed prior to the start of the surgical procedure. This would include but not be limited to induction, intubation, IV starts, central line placement, insertion of a urinary catheter, placement of pressure site padding, SSEP/MEP monitoring needles and discs. Recommendations: Beginning January 1, 2020 we implemented the algorithm inclusive of the ENTIRE orthopedic population. The service leads for Neuro, ENT, General, Urology, Opthamology and Plastics received the algorithm. They will evaluate for their individual service.