Improving Safe Thermoregulation Practices in an Urban Outpatient Surgery Center Through a Quality Improvement Initiative.

Abstract

Purpose: Inadvertent perioperative hypothermia, defined as a core temperature below 36 °C, can lead to complications but is preventable when nursing interventions follow clinical practice recommendations. At an urban outpatient surgery center in Kirkland, Washington, a quality improvement initiative was implemented to improve thermoregulation practices to 80% over 8 weeks.

Design: A rapid cycle quality improvement project, guided by the Institute of Medicine's safety aim, was carried out using the Plan-Do-Study-Act model.

Methods: Quantitative data were collected via a chart review with the PreOp Audit Tool and Postanesthesia Care Unit (PACU) Audit Tool. Interpretation of the quantitative data, in conjunction with the field notes, drove the next test of change to improve safe thermoregulation, which occurred biweekly. Team engagement scores were collected via a survey pre- and post-intervention, and means were calculated.

Findings: Safe thermoregulation increased from 62% to 92%, exceeding the 80% target. The PreOp and PACU Warming Bundle proved to be the most effective intervention.

Conclusions: Normothermia care bundles are effective in maintaining safe thermoregulation throughout the perioperative process and improve staff knowledge of clinical practice recommendations. In addition, normothermia care bundles decrease staff-perceived workload in managing normothermia.