Effect of a thermal care bundle on the prevention, detection and treatment of perioperative inadvertent hypothermia

Jed Duff; Kim Walker; Karen-Leigh Edward; Nicholas Ralph; Jo-Ann Giandinoto; Kimberley Alexander; Jeff Gow; John Stephenson

doi:10.1111/jocn.14171

Effect of a thermal care bundle on the prevention, detection and treatment of perioperative inadvertent hypothermia

J Clin Nurs. 2018 Mar;27(5-6):1239-1249. doi: 10.1111/jocn.14171. Epub 2018 Feb 1.

Authors

Jed Duff¹, Kim Walker², Karen-Leigh Edward³, Nicholas Ralph^{4

5}, Jo-Ann Giandinoto⁶, Kimberley Alexander^{7

8}, Jeff Gow^{9

10}, John Stephenson¹¹

Affiliations

¹ School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.
² St Vincent's Private Hospital Sydney, Sydney, NSW, Australia.
³ School of Health Sciences, Swinburne University, Melbourne, Vic., Australia.
⁴ Research Program Leader (Clinical Services), Institute of Resilient Regions, School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Qld, Australia.
⁵ St Vincent's Private Hospital, Toowoomba, Qld, Australia.
⁶ St Vincent's Private Hospital, Melbourne, Vic., Australia.
⁷ Holy Spirit Northside Private Hospital, Brisbane, Australia.
⁸ Queensland University of Technology, Brisbane, Qld, Australia.
⁹ School of Commerce, University of Southern Queensland, Toowoomba, Qld, Australia.
¹⁰ School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa.
¹¹ Biomedical Statistics, University of Huddersfield, Huddersfield, UK.

PMID: 29149456
DOI: 10.1111/jocn.14171

Abstract

Aims and objectives: To improve the prevention, detection and treatment of perioperative inadvertent hypothermia in adult surgical patients by implementing a Thermal Care Bundle.

Background: Keeping patients normothermic perioperatively prevents adverse surgical outcomes. Hypothermia leads to serious complications including increased risk of surgical bleeding, surgical site infections and morbid cardiac events. The Thermal Care Bundle consists of three elements: (i) assess risk; (ii) record temperature; and (iii) actively warm.

Design: A pre- and postimplementation study was conducted to determine the impact of the Thermal Care Bundle on the prevention, detection and treatment of perioperative inadvertent hypothermia.

Methods: The Thermal Care Bundle was implemented using an adapted version of the Institute of Healthcare Improvement's Breakthrough Series Collaborative Model. Data were collected from auditing medical records.

Results: Data from 729 patients (pre-implementation: n = 351; postimplementation: n = 378) at four sites were collected between December 2014-January 2016. Improvements were recorded in the percentage of patients with a risk assessment; at least one documented temperature recording per perioperative stage; and appropriate active warming. Despite this, the overall incidence of perioperative inadvertent hypothermia increased postimplementation.

Conclusion: The Thermal Care Bundle facilitated improved management of perioperative inadvertent hypothermia through increased risk assessment, temperature recording and active warming but did not impact on perioperative inadvertent hypothermia incidence. Increased temperature recording may have more accurately revealed the true extent of perioperative inadvertent hypothermia in this population.

Relevance to clinical practice: This study showed that a collaborative, context specific implementation method, such as the IHI Breakthrough Series Model, is effective at improving practices, which can improve thermal care.

Keywords: evidence-based practice; healthcare collaborative; perioperative inadvertent hypothermia.

MeSH terms

Adult
Body Temperature
Body Temperature Regulation*
Female
Fever
Humans
Hypothermia / prevention & control*
Hypothermia / therapy
Intraoperative Complications / prevention & control*
Male
Perioperative Care / methods*
Surgical Wound Infection / prevention & control
Temperature