Name
#38 Mitigating Intraoperative Hypothermia Through Prewarming - A Quality Improvement Project
Speakers
Content Presented on Behalf of
DHA
Services/Agencies represented
Defense Health Agency (DHA), US Navy
Session Type
Posters
Room#/Location
Prince Georges Exhibit Hall A/B
Focus Areas/Topics
Clinical Care
Learning Outcomes
1. Understand how general anesthesia impacts internal temperature regulation and leads to intraoperative hypothermia (IH), and identify negative outcomes associated with IH.
2. Describe the mechanics of how prewarming mitigates the effects of general anesthesia on core body temperature.
3. Learn how using an evidence-based implementation framework can lead to conducting a successful and sustainable quality/process improvement project.
2. Describe the mechanics of how prewarming mitigates the effects of general anesthesia on core body temperature.
3. Learn how using an evidence-based implementation framework can lead to conducting a successful and sustainable quality/process improvement project.
Session Currently Live
Description
Introduction: The purpose of this project was to reduce our 75% rate of intraoperative hypothermia (IH), which occurs when the body’s core temperature drops below 36C during surgery and is associated with a host of negative complications and outcomes. General anesthesia is the primary driver of this drop in temperature, and the literature shows that prewarming patients before surgery using a forced-air warmer (e.g., a Bair Hugger™) can prevent or significantly reduce rates of IH. However, our facility lacked a protocol to guide consistent and systematic use of prewarming.
Materials and methods: Over a two month period, we implemented a prewarming protocol for adult surgical patients using the Johns Hopkins Evidence Based Practice Model. During the intervention period, anesthesia technicians (ATs) preoperatively prewarmed all surgical patients undergoing general anesthesia for at least 30 minutes. Process measures captured consistent application of prewarming, length of prewarming, and patient refusal. Outcome measures captured occurrences of IH, lowest recorded core temperature during surgery, hypothermic length of time, and post-operative temperature on arrival to the post-anesthesia care unit (PACU).
Results: We observed 63 patients: 28 patients in the pre-intervention group and 35 patients in the intervention group. The ATs adhered to the protocol and correctly offered prewarming to all appropriate patients, with 81.4% warmed for at least 30 minutes. Prewarming significantly lowered the rate of IH by 42.8%, reduced time spent in hypothermia, and yielded warmer post-operative temperatures on arrival to the PACU. There were significant, but weak to moderate, correlations between length of prewarming and PACU arrival temperature.
Conclusion: The use of an evidence-based practice model combined with project leader oversight showed that a prewarming protocol can be successfully implemented at a small military treatment facility, drastically reducing the rate of IH in surgical patients receiving general anesthesia. Prewarming is a low-risk intervention and can be performed safely by trained ancillary personnel. While this project’s scale was small, our findings demonstrate that prewarming to prevent IH is feasible regardless of a facility’s size.