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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