Reducing Perioperative Hypothermia using Preoperative Warming: An Improvement Project in a Veteran Affairs Medical Center

Reducing Perioperative Hypothermia using Preoperative Warming: An Improvement Project in a Veteran Affairs Medical Center

Abstract

BACKGROUND: Perioperative hypothermia, core body temperature < 36.0°C, places patients at an increased risk of morbidity and mortality. Hypothermic complications range from life-threatening cardiac abnormalities to increased surgical site infections. Globally, colorectal patients under general anesthesia have a hypothermic incidence rate of 67-74%.

LOCAL PROBLEM: The project setting was a 114-bed acute care tertiary Veterans Affairs hospital. A strengths, weaknesses, opportunities, and threats (SWOT) analysis revealed the lack of standardization when patients were warmed in the preoperative area. This project aimed to implement 30 minutes of forced-air warming (FAW) in the preoperative period for colorectal surgical patients.

METHODS: The evidence-based practice improvement (EBPI) model and plan-do-study-act (PDSA) cycles were utilized for this project. The total warming time and preoperative and postoperative temperatures were measured.

INTERVENTIONS: 30 minutes of forced-air warming (FAW) in the preoperative period was implemented for all colorectal surgical patients (age 18 or older).

RESULTS: Three colorectal surgical patients were identified during our 12-week implementation period. Two of the three patients refused the FAW blanket. All three patients had a core temperature >36.0°C. The one patient who used the FAW blanket for the requisite 30 minutes had a final operating room temperature higher than the other three patients. Consistent with our aims, 100% of participating patients were pre-warmed for at least 30 minutes and had a final operating room temperature >36.0°C.

CONCLUSIONS: Even with our limited patient participation, 30 minutes of preoperative warming maintained normothermia and increased final operative core temperatures, consistent with our literature review. Patient participation was an unanticipated challenge for this project. Incorporating pre-anesthesia patient education regarding the use of FAW may be another avenue for future projects. Patient education and biannual preoperative nurse education will create a foundation for sustainability at our project site.

keywords: perioperative hypothermia, forced-air warming, colorectal surgery