REAL TIME Phoenix Children's Hospital trialed a prewarming protocol on a small group of spinal fusion patients before rolling it out to its entire orthopedic service line.
If you want to roll out a patient warming protocol that requires your facility to invest time, resources money — and, of course, a change to the status quo — you need to give leadership a compelling reason why the move is a worthwhile investment. We knew that active patient warming helps to prevent unplanned perioperative hypothermia, but our hospital didn't have a standardized method to warm patients, so we gradually launched a successful prewarming protocol across our entire orthopedic service line, and what we learned during the process could convince you to make changes to your own patient-warming protocols.
Starting small
Your first order of business is to create a warming protocol that's effective, repeatable and right for your facility. You don't have to reinvent the wheel; there are plenty of resources available to guide you, including evidence-backed guidelines from organizations such as AORN. Obviously, the protocol will vary from facility to facility, and there are a number of different warming methods to choose from (forced-air warming, conductive fabric devices, circulating water devices), but the most important component is choosing a process that employs active warming, which, as the name suggests, warms patients with an external source of heat, as opposed to passive warming tactics, which only prevent insulation against heat loss — warm blankets, for example.
I also recommend starting small. Procedural changes are a tough sell, especially when those changes involve multiple staff levels (nurses, surgeons, techs and anesthesiologists). After some open discussions with our surgeons and anesthesiologists about our options, we decided to prewarm neuromuscular (NM) spinal fusion patients with warming gowns. While we eventually made changes to all our orthopedic procedures, we started with this small subset of patients, a group that is significantly exposed during surgery. We'd always had trouble maintaining normothermia (core body temperature of 36˚C) in them, and we needed to protect this vulnerable group from the many potential adverse reactions of hypothermia — infection, poor wound healing, increased blood loss (and the potential need for a transfusion), decreased renal function and prolonged hospitalization.
