Maintaining Normothermia: Implementing AORN's Updated Patient Temperature Management Guideline

Maintaining normothermia—a normal body temperature—is crucial for patient safety during surgical procedures. The AORN (Association of periOperative Registered Nurses) updated guideline on patient temperature management, features an expanded scope and provides perioperative teams with the tools they need to implement consistent, high-quality care.

From Hypothermia Prevention to Comprehensive Temperature Management

The most significant change to the guideline is its name and scope. Previously focused solely on hypothermia prevention, the updated guideline now addresses patient temperature management, encompassing both hypothermia and malignant hyperthermia. This expansion reflects a more holistic approach to temperature regulation throughout the perioperative journey.

A Collaborative Effort: Building the Patient Temperature Management Guideline

AORN's guideline advisory board, also known as the "GAB," plays a critical role in the process. Comprised of perioperative nurses, a patient advocate, and liaisons from various organizations, including the American Association of Nurse Anesthesiology, the American College of Surgeons, and the Association for Professionals in Infection Control and Epidemiology (APIC), the GAB ensures the guideline reflects the multifaceted nature of perioperative care.

How Perioperative Teams can Maintain Normothermia

Several key updates enhance the guideline's practicality and effectiveness:

Patient Temperature Management Plan:

A new section guides facilities in developing comprehensive patient temperature management plans. This includes strategies for preventing both hypothermia and malignant hyperthermia, as well as quality assessment measures. The guideline even provides a sample perioperative normothermia bundle to help teams get started.

Emphasis on Active Patient Warming:

The guideline reinforces the importance of active warming methods, such as forced-air warming, over passive insulation. Research demonstrates that active warming is more effective in raising patient temperature and preventing hypothermia, especially during general anesthesia. Passive insulation alone isn't sufficient for preventing hypothermia in these patients.

Intraoperative and Postoperative Patient Warming:

Two new recommendations highlight the importance of continuous warming throughout the surgical process, from the intraoperative phase to the postoperative period. Minimizing interruptions to warming is crucial for preventing hypothermia.

Preoperative Assessment:

The guideline now includes preoperative assessment to identify patients at risk for hypothermia. While the research on specific risk factors remains somewhat inconsistent, the guideline emphasizes the importance of considering factors like age (using terms like "older" and "younger" due to inconsistent age-related research) and other patient-specific conditions. The guideline also acknowledges the need for more validated, user-friendly hypothermia risk assessment tools.

Patient Temperature Monitoring Devices:

A new recommendation encourages pre-purchase evaluations of all devices used for patient temperature management, including those used for temperature measurement and active warming and passive insulation. The guideline's rationale section synthesizes the evidence on the accuracy of various devices, including newer devices that can track patient temperature consistently throughout the perioperative journey.

How to Implement the Patient Temperature Management Guideline: A Perioperative Team Approach

Effective implementation requires interdisciplinary collaboration. Teams should work together to:

• Develop a standardized patient temperature management plan.
• Establish clear policies and procedures.
• Design a normothermia bundle.
• Monitor progress and track patient outcomes.
• Provide staff education and competency verification.
• Ensure that thermometers and warming devices are readily available, properly maintained, and used correctly.

Overcoming Challenges and Misconceptions of Normothermia

Several challenges can hinder guideline implementation, including cost, resource allocation, and staff adherence. However, the costs associated with not preventing hypothermia—such as increased surgical site infection (SSI) risk, cardiac complications, bleeding, pain, and longer hospital stays—far outweigh the investment in proper temperature management.

One common misconception is that short surgical cases don't pose a risk for hypothermia. Research shows that body temperature can drop significantly within the first hour after general anesthesia induction, regardless of case length. Therefore, even short procedures require proactive temperature management strategies.

Accessing Resources and Tools for Patient Temperature Management

AORN Guideline Essentials provide a wealth of resources to support guideline implementation, including:

• Educational presentation slides
• Clinical FAQs
• Case studies
• Videos

These resources, along with the tools migrated from the previous hypothermia prevention tool kit, are available to AORN members and are designed to facilitate consistent and effective temperature management practices.

Maintaining normothermia is a fundamental aspect of patient safety. By embracing AORN's updated guideline and utilizing the available resources, perioperative teams can ensure that all patients receive the best possible care.

How can Perioperative Nurses Access the AORN Patient Temperature guideline?

AORN's updated Patient Temperature Management guideline is a valuable resource for all members of the perioperative team and provides a more holistic approach to temperature management. The updated guideline can be found in eGuidelines+, as well as the 2025 print guideline book and ebook.