Transcript Slide 1
Feel the Warmth:
Keeping Patients Warm During Surgery
Surgical Services Physicians & Staff
SAC, OR, Anesthesia & PACU
Endorsed by OR/PAR Committee
SCIP: Surgical Care Improvement Project
Surgical site infections (SSI) are a major complication after
surgery, resulting in considerable morbidity, mortality, and
resource utilization. The costs of SSI vary depending on the
type of surgery and infecting pathogen; estimates range from
$3,000-$29,000.1 Proper use of antibiotics – giving the right
drug at the right time – is effective in preventing infections
after surgery.2 Other perioperative measures - glucose
control, appropriate hair removal, and maintaining
temperature control - have also been proven effective in
reducing infections.
1
Deverick, JA, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals, Infection Control & Hospital Epidemiology October 2008
Supplement; 29:S51-61
2
Bratzler, DW, et al. Use of Antimicrobial Prophylaxis for Major Surgery: Baseline Results from the National Surgical Infection Prevention Project, Arch Surg
Feb 2005; 140:174-182.
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Loyola’s success with SCIP measures
Measure
Compliance
Antibiotics given within 60 minutes of
surgical incision
96%
Appropriate antibiotic
97%
Antibiotics stopped within 24 hours
after surgery
96%
Controlled post operative serum
glucose
94%
Appropriate hair removal
99%
Post operative temperature control
75%
2008/2009 activities were focused to improve
post operative temperature control
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Keeping Surgical Patients Warm
Why is it important?
Prevention of hypothermia reduces hospital length of stay, surgical site
infections, blood loss, post-op shivering, redistribution hypothermia, the
need for blood transfusions and altered medication metabolism.
Historically this publicly reported measure has only applied to colon
surgeries. In 2009, it will be expanded to include all surgeries greater
than 60 minutes.
Baseline performance:
Colon surgeries – 75% compliance
All surgeries – 71% compliance
Goal:
All patients undergoing surgery will achieve normal body temperature
(normothermia) immediately after surgery. Normothermia is defined as
a temperature of 96.8°F – 100.4°F.
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Tests of change to improve normothermia
Cycle One
What we did:
Initiated passive and active warming techniques preoperatively
in the Surgical Admitting Center and Pre-op Holding:
Passive warming: thermal hats, slippers, thermal blankets
Active warming: Forced warm air device (bair hugger) as indicated,
and warmed fluids for infusions
What we learned:
Noted improved compliance with post op normothermia
Patient temperatures in the OR were low
Inconsistent MD/Staff compliance with warming measures
OR/PAR Committee agreed to continue the pilot
Confidential: Quality Improvement Material
Tests of change to improve normothermia
Cycle Two:
What we did:
Passive warming: thermal hats, slippers, thermal blankets
Active warming: Forced warm air device (bair hugger) as
indicated, and warmed fluids for infusions
NEW: Increased the Operating Room temperature to 72
degrees at beginning of case
What we learned:
Noted decreased compliance with post op normothermia
Patients complained of being too hot; they took their
warming devices off
Confidential: Quality Improvement Material
Tests of change to improve normothermia
Cycle Three:
What we did:
Passive warming: thermal hats, slippers, thermal blankets
Active warming: Forced warm air device (bair hugger) as
indicated, and warmed fluids for infusions
Set up automatic changes to increase the Operating Room
temperature to 72 degrees at beginning of case
NEW: Patient education/Staff education
What we learned:
Noted improved compliance with normothermia
Improved patient compliance with warming devices
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Improved compliance with normothermia
100
95
90
90
80
80
70
71
60
50
Baseline
Cycle One
Cycle Two
Cycle Three
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Results and Analysis
Improved compliance with normothermia:
100% compliance for colon surgery patients
95% compliance for all surgical patients in the final cycle
Project success factors:
Use of perioperative passive and active warming measures
Surgical Admitting Center
Pre-op Holding
Operative Rooms
Post Anesthesia Recovery
Maintenance of appropriate Operating Room temperatures
Physician/Staff education
Patient education
Confidential: Quality Improvement Material
Next Steps
Incorporate a standard reminder at the end of each
procedure
“Re-warm the patient”
Continue awareness education
Physicians and staff
Patients and families
Monitor ongoing performance:
Analyze outliers and collaborate to improve
Magnet Forces: 6 - Quality of Care; 7 - Quality
Improvement; 13 - Interdisciplinary Relationships
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