Implementing Safe and Effective Patient Warming

All patients have their peripheral temperatures monitored in the OR by a skin temperature sensor that attaches to the anesthesia machine. Temperatures are documented in the patient’s health record and communicated verbally if a patient’s temperature requires additional warming to achieve normothermia. A normothermia outcome equal to or better than 36°C within 15 minutes of arrival in the PACU is tracked for patients whose surgical procedure is longer than 60 minutes. Ms. Hain says her center is at 100% compliance for this outcome.

At Valley Surgery Center in Scottsdale, Ariz., every patient receiving general anesthesia gets a forced-air warming system blanket at the start of their stay, according to Nurse Administrator Meghan Quinn, RN. This blanket is attached to the forced-air machine once the patient is transferred to the OR table and prior to receiving anesthesia.

Throughout intraoperative care, the patient’s peripheral temperature is monitored by the anesthesia professional and documented on the anesthesia record. “If there are any issues with the temperature of the patient, anesthesia will communicate this with the OR team,” explains Ms. Quinn, noting that this communication is an important part of their standardized protocol for maintaining patient normothermia. 

Here are a few tips for implementing effective patient warming practices.

• Create consistency. Standardization is a key factor in making sure a patient warming protocol is practiced the same way for every patient, acknowledges Ms. Quinn. To shape her facility’s patient warming protocol, she worked with a team of nurses, physicians, surgical techs and anesthesia care professionals to draft a policy and procedure that includes each representative’s role in patient warming practices. Ms. Quinn stresses the importance of including anesthesia professionals in this work because they play a big part in patient warming and temperature monitoring.

• Document and assess. As with any new protocol, Ms. Hain suggests having a clear plan for how a patient warming protocol will be completed and documented. Every patient warming encounter is documented in the patient’s chart to show all warming steps have been completed. She also runs a quarterly report for procedures lasting more than 60 minutes, evaluates these patients’ PACU temperatures at or below normothermia and uses a spreadsheet to track outcomes data according to the name of the anesthesia professional who was in the room for the surgery.

• Talk about best practices. One important way to increase long-term sustainability of patient warming is to share the benefits of it with staff, according to Ms. Hain. “If the team realizes that this is not just something else to chart but something that ensures patients will have a better, happier stay, nurses will be on board,” she says.

Reviewing recommendations in the AORN Guideline for Prevention of Hypothermia is one way to help teams realize all the benefits of warming, including patient satisfaction and improved surgical outcomes. Dr. Spruce highlights a few recommendations from the guideline to discuss as a team. Select the temperature measurement site and method in collaboration with the perioperative team based on the requirements of the procedure, anesthesia type, anesthesia delivery method, accessibility of the body site for measurement and invasiveness of the method. Use the same site and method of temperature measurement throughout the perioperative phases when clinically feasible.

When hypothermia is identified before surgery, preoperative staff should initiate interventions to normalize the patient’s core body temperature before the patient is transferred to the operating room, if possible.

AORN’s guideline also includes a few important reminders for the team. Don’t take a patient’s word that they are warm because research has shown that a patient may confirm thermal comfort but actually be hypothermic. Know that 80% of the time, redistribution of body heat from the core to the periphery is the reason for a drop in body temperature during the first hour after general anesthesia is initiated and can cause a patient’s core temperature to drop by 0.9°C to 2.7°C.

Remember that a patient who is hypothermic as they recover from anesthesia will shiver as a natural response and this can negatively impact their recovery because shivering may increase surgical site pain, intracranial pressure and oxygen consumption. OSM