Maintaining Intraoperative Normothermia Using Under-Body Forced Air Warming: A Quality Improvement Project

Background: Intraoperative hypothermia occurs when a patient has a core temperature less than 36.1 degrees Celsius. It is a common occurrence and it occurs anywhere from 26-90% of the time patients are in the operating room. At the Huntsman Cancer Hospital, over 40% of surgical patients experience periods of hypothermia. The physiological complications associated with intraoperative hypothermia leads to increased cost to the patient from longer intensive care unit (ICU) stays and overall longer hospital admissions. Intraoperative hypothermia has adverse effects on a patient's overall outcome, but is preventable due to knowledge of its causative factors. Methods: Using an under-body forced air warming blanket, a quality improvement (QI) project aimed to reduce the incidence of hypothermia at surgical incision time. Nursing staff at the Huntsman Cancer Hospital were asked to identify their knowledge of maintaining patient normothermia and when the under-body blanket is appropriate. An educational presentation provided the staff with information on current data about hypothermia, determining when patients become hypothermic intraoperatively, and on implementing the under-body blanket. Staff members completed post-education questionnaires that assessed the effectiveness of the education presentation. Compliance documentation was done to track usage of the under-body blanket with health-care assistants (HCA) and then circulating nurses. The compliance for documentation was compared between the two groups. Intraoperative hypothermic events were measured before and during implementation to assess change. Results: A decrease in the number of hypothermic incidences at start of surgery was noted. There were 489 surgical cases at the Huntsman Cancer Hospital during implementation. Of those cases, 32% (n=157) were hypothermic at surgical start time (t=0), compared to the pre- intervention group of 430 patients with a 43% hypothermic rate (n=185). A chi squared test found that the difference between the pre- and post-implementation groups was statistically significant X2 (1, N=919) =11.67, p < .001). Documentation compliance of under-body blanket use increased from 27% to 61% when changing the compliance tracking spreadsheet responsibility to the circulating nurse. To examine differences in documentation, a chi square test was used to assess compliance between HCAs (101/461, 22%) and the nurses (296/489, 61%), finding that nurses completed documentation more often than HCAs; this was statistically significant X2 (1, N=950) =145.51, p < .001. During the pre-implementation time period, hypothermic incidence decreased to 26% at 120 minutes after surgical incision time (t=120). During implementation, hypothermic incidence decreased to 17% at t=120. Conclusions: Decreases in hypothermia at surgical start time with the implementation of the under-body forced air warming blanket suggests that the total number of patients that enter into a hypothermic state is reduced therefore decreasing their risk for physiological complications. Compliance with documentation tracking use of the under-body blanket improved when the responsibility was changed to the circulating nurse. In addition, patient temperature recovery to normothermia appears to be similar when compared to the pre-intervention group.