Implementation of a Warming Bundle to Decrease Incidences of Postoperative Hypothermia

Abstract

Problem: At an Ambulatory Surgical Center (ASC) associated at a large urban academic medical center, a high frequency of perioperative hypothermia was noted. In the Fall of 2022, between 79.2% and 92.1% of patients were within the normothermia range of 36ºC within 15 minutes of arriving to the Post Anesthesia Care Unit (PACU), falling below the benchmark goal of 95%. Purpose: Literature shows that postoperative temperatures below 36ºC can negatively impact patient comfort, recovery, and risk for infection. This project aimed to implement and evaluate an evidence-based warming bundle intervention perioperatively to decrease incidences of postoperative hypothermia. Methods: Staff were educated on the current normothermia policy, context of the project, methods of evaluation, as well as how to properly use temporal artery thermometers and forced air warming (FAW) devices, and education was reinforced through email communication. Nurses in the preoperative unit performed screening of patients meeting criteria, and implementation team members accessed audit tools using QR codes and web links at discharge. Data was collected via a HIPAA compliant, password-protected server, which was only accessible by the Quality Improvement Project Lead (QI-PL) and project faculty. Results: Over a 15-week period in the Fall of 2023, the warming bundle was utilized for 196 patients. Of those, 71 patients (36.2%) had all elements of the warming bundle completed. Within the 71 patients, 100% had a documented normal temperature; averaging 36.3ºC in the PACU post bundle implementation. Conclusions: Implementation of an evidence-based warming bundle intervention has been found to decrease incidences of postoperative hypothermia. Hypothermia and future considerations should include standardizing warming interventions, which could potentially reduce postoperative hypothermia. Keywords: perioperative warming, postoperative hypothermia, normothermia, warming bundle