Feel the Warmth: Keeping Patients Warm During Surgery Surgical Services Physicians & Staff SAC, OR,...

Feel the Warmth:Keeping Patients Warm During Surgery

Surgical Services Physicians & StaffSAC, OR, Anesthesia & PACU

Endorsed by OR/PAR Committee

SCIP: Surgical Care Improvement Project Surgical site infections (SSI) are a major complication after

surgery, resulting in considerable morbidity, mortality, and resource utilization. The costs of SSI vary depending on the type of surgery and infecting pathogen; estimates range from $3,000-$29,000.1 Proper use of antibiotics – giving the right drug at the right time – is effective in preventing infections after surgery.2 Other perioperative measures - glucose control, appropriate hair removal, and maintaining temperature control - have also been proven effective in reducing infections.

1 Deverick, JA, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals, Infection Control & Hospital Epidemiology October 2008

Supplement; 29:S51-612

Bratzler, DW, et al. Use of Antimicrobial Prophylaxis for Major Surgery: Baseline Results from the National Surgical Infection Prevention Project, Arch Surg Feb 2005; 140:174-182.

Confidential: Quality Improvement Material

Loyola’s success with SCIP measuresMeasure Compliance

Antibiotics given within 60 minutes of surgical incision

96%

Appropriate antibiotic 97%

Antibiotics stopped within 24 hours after surgery

96%

Controlled post operative serum glucose

94%

Appropriate hair removal 99%

Post operative temperature control 75%

2008/2009 activities were focused to improve post operative temperature control


Keeping Surgical Patients Warm

Why is it important? Prevention of hypothermia reduces hospital length of stay, surgical site

infections, blood loss, post-op shivering, redistribution hypothermia, the need for blood transfusions and altered medication metabolism.

Historically this publicly reported measure has only applied to colon surgeries. In 2009, it will be expanded to include all surgeries greater than 60 minutes.

Baseline performance: Colon surgeries – 75% compliance All surgeries – 71% compliance

Goal: All patients undergoing surgery will achieve normal body temperature

(normothermia) immediately after surgery. Normothermia is defined as a temperature of 96.8°F – 100.4°F.


Tests of change to improve normothermia

Cycle OneWhat we did:

Initiated passive and active warming techniques preoperatively in the Surgical Admitting Center and Pre-op Holding:

Passive warming: thermal hats, slippers, thermal blankets Active warming: Forced warm air device (bair hugger) as indicated,

and warmed fluids for infusions

What we learned: Noted improved compliance with post op normothermia Patient temperatures in the OR were low Inconsistent MD/Staff compliance with warming measures OR/PAR Committee agreed to continue the pilot



Cycle Two:

What we did: Passive warming: thermal hats, slippers, thermal blankets Active warming: Forced warm air device (bair hugger) as

indicated, and warmed fluids for infusions NEW: Increased the Operating Room temperature to 72 degrees

at beginning of case

What we learned: Noted decreased compliance with post op normothermia Patients complained of being too hot; they took their warming

devices off



Cycle Three:What we did:

Passive warming: thermal hats, slippers, thermal blankets Active warming: Forced warm air device (bair hugger) as

indicated, and warmed fluids for infusions Set up automatic changes to increase the Operating Room

temperature to 72 degrees at beginning of case NEW: Patient education/Staff education

What we learned: Noted improved compliance with normothermia Improved patient compliance with warming devices


Improved compliance with normothermia

71

90

80

95

50

60

70

80

90

100

Baseline Cycle One Cycle Two Cycle Three


Results and Analysis

Improved compliance with normothermia: 100% compliance for colon surgery patients 95% compliance for all surgical patients in the final cycle

Project success factors: Use of perioperative passive and active warming measures

Surgical Admitting Center Pre-op Holding Operative Rooms Post Anesthesia Recovery

Maintenance of appropriate Operating Room temperatures Physician/Staff education Patient education


Next Steps

Incorporate a standard reminder at the end of each procedure “Re-warm the patient”

Continue awareness education Physicians and staff Patients and families

Monitor ongoing performance: Analyze outliers and collaborate to improve


Magnet Forces: 6 - Quality of Care; 7 - Quality Improvement; 13 - Interdisciplinary Relationships

Feel the Warmth: Keeping Patients Warm During Surgery Surgical Services Physicians & Staff SAC, OR,...

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