Prevention of Intraoperative Hypothermia for Patients Undergoing Gynecologic Surgery

Abstract

Problem & Purpose: Intraoperative hypothermia, defined as core body temperature less than 36 degrees Celsius, is an anesthetic complication which can lead to adverse events such as increased risk of infection, delayed emergence, and increased cost to the hospital. Intraoperative hypothermia affected approximately 50% of gynecologic surgical patients at an acute care hospital in Baltimore, Maryland. The purpose of this project was to implement and evaluate the compliance of a preoperative warming protocol among patients undergoing gynecologic procedures. The preoperative warming protocol included the use of forced air warming at the maximum setting for the 30 minutes prior to surgery. The goal of the project was for 100% of eligible patients to receive the warming protocol and for 100% of patients to avoid intraoperative hypothermia. Methods: A team of 17 Certified Registered Nurse Anesthetists, seven physician Anesthesiologists, and 12 Registered Nurses were mobilized to implement the evidence based warming protocol. Education was provided via in person sessions and posted information throughout the preoperative area. Providers were expected to warm all eligible patients for 30 minutes using a forced air warming device immediately prior to the procedure. The anesthesia staff used quick response codes to document use of the protocol and incidence of intraoperative hypothermia. Data was monitored weekly and stored on Research Electronic Data Capture. Results: Overall, a total of 41 patients received the warming protocol over 15 weeks. Anesthesia provider compliance with the protocol was 38.2%. Compliance peaked at 100% in week one and 11. A total of 90.2% of patients who received the warming protocol did not experience intraoperative hypothermia. Conclusion: The data suggests the preoperative warming protocol is effective, feasible, and sustainable. Compliance required ongoing reminders and frequent communication.