Normothermia: Our Journey

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Normothermia Our Journey

• Safer HealthCare Now!
• Eating the Elephant
• March 12, 2009
• Zaida Wilson RN CPN (c),
• Manager OR/Endo/PACU/OPPU
• Joseph Brant Memorial Hospital
• Burlington, Ontario

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Objectives

• Overview of normothermia as part of the SSI
  bundle
• How we got our staff and physicians
  committed/engaged
• Data capture
• Roadblocks to success
• Contact Information

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Evidence shows 4 components reduce the incidence
of SSI . . .

• Appropriate use of antibiotics
• Appropriate hair removal
• Maintenance of post-op glucose control
• Post operative normothermia

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Perioperative Normothermia

• Medical literature demonstrates that patients
  undergoing surgery have a decreased rate of SSI
  if they remain normothermic during the
  perioperative period.

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Causes of Hypothermia

• Anaesthesia
• Anxiety
• Wet skin preparations
• Skin exposure in cold ORs

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Warming Best Practices

• Warmed forced air blankets OR PACU
• Warmed IV fluids
• Increase ambient temperature in OR theatre
• Use hats and booties
• Pre-warming immediately before procedure

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• Our Warming Practices
• Warm blanket on arrival to OR and end of case
• Bair Hugger, either full or upper body
• Warm IV fluids for anaesthetic use and irrigation
• Ranger fluid during lengthy procedures
• Level One Infuser on major cases where fluid loss
  is anticipated

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SHN Data Collection

• Includes ALL open abdominal surgeries
• Colorectal
• Urology, nephrectomy, prostatectomy
• Hysterectomy (excluding vaginal)
• Thoracic, pneumonectomy

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Team members

• Zaida Wilson, OR Manager
• Sue Allard, Infection Prevention Control
  Practitioner
• Jan Irwin, Meditech OR/Nursing Systems
• Data Analyst
• OR/PACU nursing and clerical staff

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What is our Goal?
The Gold Standard

• Keep the patients core temperature above 36
  Celsius throughout the entire surgical
  intervention and into the Post-Anaesthetic Care
  Unit portion of care.

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Data Collection

• Post Operative Anaesthetic Care Unit staff
  measure the patients temp on arrival in PACU,
  using a tympanic temperature probe.
• Temperature is transcribed by the PACU nurse onto
  the OR Record in a section provided for that
  purpose.

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Data Collection (contd)

• Clerk enters the temp value into the Meditech OR
  Module
• An NPR report extracts the data from the Meditech
  OR Module monthly
• Currently the OR Manager inputs the report to SHN
  monthly.

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Results

• Data collection began March, 2008
• First month showed 70 patients were normothermic
• Subsequently, monthly rate has varied from
  40-60.

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Review of declining percentages

• Reviewed patient temperature in OR
• normothermic
• Reviewed warming practices in the OR
• best practice in place
• Reviewed data collection procedures
• PACU staff not recording temp on appropriate
  cases.
• Thermometer also an issue (tympanic tends to read
  at least 1 below actual core temp)

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Improvement Initiatives

• Re-educate staff re need to record temperature.
• Staff decided to record temp on ALL patients to
  keep it simple!
• Modify Meditech report to choose appropriate
  cases
• Open abdominal
• Begin trial of temporal thermometer to provide
  more accurate core temperature readings.

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Next Steps

• Review temporal thermometer trial results
• Assign data clerk to data entry for SHN!
• enable manager to focus on performance
  improvement rather than data entry
• facilitate more timely reporting

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Contact Information

• Zaida Wilson RN,CPN (c)
• Manager, OR/Endo/PACU/OPPU
• Joseph Brant Memorial Hospital
• zwilson_at_jbmh.com