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.
Confidential: Quality Improvement Material
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
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Surgical Admitting Center
Pre-op Holding
Operative Rooms
Post Anesthesia Recovery
 Maintenance of appropriate Operating Room temperatures
 Physician/Staff education
 Patient education
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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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