Preventing Perioperative
Hypothermia
Victoria M Steelman, PhD, RN, CNOR, FAAN
Jon H. Lemke, PhD
June 3, 2014
General & Neuraxial Anesthesia
• Shift heat from core to peripheral tissues
• Diminish the response to cold
• Result in most of the patients undergoing
surgery experiencing perioperative
hypothermia unless effective prevention is
used.
Sessler 2008
Adverse Outcomes of Mild
Perioperative Hypothermia
• Triples the risk of surgical site infection,2
• Quadruples the risk of morbid cardiac events,3
• Increases blood loss4, 5 and use of blood transfusions
• Increases the duration of action of anesthesia and neuromuscular blocking agents6
• Extends postanesthesia recovery by an average of 90 minutes.6
• Increases the cost of care of a surgical patient by an average of $2500 to $7000 per patient.7
Evidence-based Practice
Forced Air Warming (FAW)
Forced Air Warming
• Numerous clinical trials have demonstrated that intraoperative forced air warming is an effective intervention for preventing perioperative hypothermia.21-24
• More effective than
• cotton blankets,19, 24
• reflective blankets,24 or
• thermo-lite® insulation.21
Preoperative Forced Air Warming
• To be most effective, forced air warming
should be applied for at least 30 minutes
preoperatively
• Decreases the gradient in temperature between
the core and periphery
• Minimizes redistribution hypothermia
Andrzejowski et al. 2008; Horn et al. 2002; Vanni et al. 2003
Quality Performance Measure
• National Quality Forum endorsed
• TJC, CMS
• Compliance requires either:
• using active warming intraoperatively or
• achieving normothermia near the end of
anesthesia
• Compliance can be achieved without
appropriately using active warming
Aim
• To determine to what extent compliance
with the NQF-endorsed quality performance
measure, is congruent with normothermia at
the end of the surgical procedure
Methods
• Retrospective review
• Patients undergoing surgery with general or
neuraxial anesthesia during a 48-month
period of time
• N = 10,763
Results
• 5.8% of patients for whom the quality
performance measure was met were
hypothermic
• Urology (8.5%)
• Orthopedics (7.7%)
Conclusions
• Patients who receive care compliant with
the quality performance measure by
receiving active warming are still at risk for
hypothermia
• Effective use of forced air warming is
needed
• Preoperatively
• Intraoperatively before induction of anesthesia
Implementing Safe Practices for Prevention of
Peri-operative Hypothermia
Purpose of AHRQ grant:
Develop and evaluate a National Tool Kit for
the effective use of forced air warming
(FAW).
Tool Box Components • Identify Champions for Change
• Contracts and Executive Level Visibility
• Education: HealthStream, Simulation Labs
• Media Coverage
• Develop Target Procedure List
• Roll Out Meetings
• Posters
• Chili Cook Off
• Timing Studies to assure that Supplies are Optimally Placed
• Tracking and Analysis of Metric Performances
• Daily Data Monitoring
Quality Performance Metrics
• Process
• Percent of OPCC patients receiving expected
preoperative FAW.
• Percent of these OPCC patients with FAW
engaged intraoperatively prior to anesthesia.
• Outcomes
• Percent of targeted patients with hypothermia at
the end of anesthesia.
• Percent of all surgical patients with
hypothermia at the end of anesthesia.
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