If you don't start actively warming patients until they enter the OR, you're "already behind the 8-ball," says Kim York, BSN, MS, RN, CNOR, CSSM, the director of surgery at Dosher Memorial Hospital in Southport, N.C. She learned this lesson the hard way while working at her last job, as a circulating nurse with a different medical center in North Carolina.
"We were doing a good job of warming patients post-operatively, but by then we were playing catch-up," she says. "We had a number of patients in PACU that were cold. After evaluating what was going on, we found out not enough people [on staff] knew about the dangers of perioperative hypothermia."
The hospital was using forced-air warming blankets intra-operatively as its primary mode of maintaining normothermia, but it wasn't quite enough. Ms. York says more than 90% of the facility's patients were "adequately warm" when they arrived in PACU, but the remaining patients were hypothermic. So she did something about it.
Her "project," as she calls it, was to revamp the hospital's culture. She began with a thorough evaluation of current perioperative processes, followed by educational outreach to all perioperative services personnel and follow-ups to ensure staff compliance. In other words, managing hypothermia earlier into the process became a team mission. The result: normothermia in 100% of patients.
How did they get there? The turnaround started in pre-admissions, where staffers were asked to educate patients about the risks associated with hypothermia and the need for active warming. But, as Ms. York remembers it, "the bulk of the problems" were in pre-op.
In the course of the process review, Ms. York learned that members of the housekeeping staff would turn down the temperatures in each room when they came in to clean at the end of each day, meaning a.m. patients arrived in a cold room and it stayed cold throughout the day unless patients spoke up.
A new plan was put into action, including the adoption of warming IV fluids and other pre-operative warming methods, such as warmed cloth blankets in pre-op. The hospital also increased the ambient temperature for pre-op holding rooms to 70 degrees, and members of the housecleaning staff were instructed to keep it there.
They opted to inch up ambient OR temperatures as well, to no less than 68 degrees. To make sure surgeons could stay comfortable given the increase, the hospital purchased cooling vests for surgical staff "They loved them," Ms. York insists meaning patients and surgeons alike could remain comfortable in the OR.