Introduction

Welcome to the APSA Quality and Safety committee Perioperative Thermoregulation Toolkit. This page is intended to help anyone who is interested in Quality Improvement (QI) pertaining to the prevention of perioperative hypothermia.

Available toolkit projects are listed below. Many of the approaches described are evidence-based - some are not. These approaches have not been approved by APSA.

Projects

At Hasbro Children’s Hospital, a lack of standardization of temperature monitoring and warming of pediatric surgical patients was noted during the development of a colorectal bundle. Therefore, a QI initiative pertaining to preoperative warming was undertaken with the aim of establishing a standard assessment for monitoring patients and to implement measures to improve preoperative temperature maintenance. The project is in its launching phase, and baseline data is being collected.

Protocol:

• Meeting with perioperative nursing leadership to discuss the situation. Agreement of a 2-week period of documentation of preoperative admission and discharge temperatures in order to determine the magnitude of problem.
• Collaborative efforts with the nursing team to determine the most effective ways of warming individual pediatric patient groups, with the following agreements:
  • Temperature in the preopative suite is set by engineering (no local control) to a pre-specified range
  • Non-ambulatory patients are warmed with heat-conserving blankets and parental care, where appropriate
  • Toddlers and children of play age are dressed in specially designed heat conserving jackets and pants
  • Pre-teens and teens, who generally sit in chairs preoperatively to watch TV or play video games, are warmed with heat conserving blankets
• Implementation of warming measures
• Post-implementation 2-week monitoring cycle to determine compliance with new measures and effect of changes

Resources:

Stakeholders: surgeons, anesthesiologists, preoperative nursing

Challenges and Solutions: Compliance with assessments

Links to published data (used to develop the protocol):

Submitted by: Elizabeth Renaud, MD

At Nemours/Alfred I. DuPont Hospital for Children, a multidisciplinary project was implemented to prevent perioperative hypothermia in NICU patients. During the project design and implementation phases, stakeholders convened and met on monthly basis for a year. A standardized postoperative handoff process was developed during this time.

Protocol:

• Nemours (DE) PPT - Hypothermia Prevention and Safe Handoff Protocols (Guidelines for heat loss prevention and temperature monitoring, workflow diagram describing the ideal communication between the OR and NICU to facilitate an effective patient handoff, structured postoperative handoff form)

Resources:

Stakeholders: NICU nursing, OR nursing, surgery, anesthesia, neonatology

Challenges and Solutions:

Links to published data (used to develop the protocol): [1]

Submitted by: Loren Berman, MD

St. Joseph’s Children’s Hospital developed the "Thermoregulation Guidelines for the Care of the Pediatric Patient" with the purpose of preventing and reducing the number of pediatric patients that experience inadvertent or unintended hypothermia.

Protocol:

• Multidisciplinary team meetings with anesthesiologists/CRNAs, pediatric preoperative/PACU personnel, OR staff, ER, radiology, floor nursing and ICU representation to address concerns and solutions
• Development of the "Thermoregulation Guidelines for the Care of the Pediatric Patient" based on current evidence-based literature and feedback from the staff
  • St. Joseph’s Children’s Hospital Thermoregulation Guidelines for the Care of the Pediatric Patient
• Dissemination of the guidelines to multiple bodies (OR Directors Collaborative, Surgical Professional Practice Council, SJCH Quality Council, Medical Executive Council and Medical Staff Advisory Council) for approval
• Departmental guideline distribution for staff education
• Audits to evaluate the effectiveness of guidelines

Resources:

Stakeholders:

• Medical Director of Pediatric Anesthesia, Dr. Thomas Moroney
• Medical Director of Pediatric Surgery, Dr. Grant Geissler
• Director of Surgical Services, Mary Robinson, RN
• Director of Patient Services, Babette Bailey, RN
• Manager Pediatric PreOp/PACU, Gabrielle Carriles, RN
• Manager Imaging Services, Rita Carracela RT
• Manager of Emergency Services, Felicia Glover, RN
• Pediatric Surgical Program Coordinator, Kirsten Yancy, RN

Challenges and Solutions:

• Challenges:
  • Coordination of multidisciplinary meetings
  • Buy-in from all staff on the importance of preventing inadvertent hypothermia
  • Rollout and education of the guidelines
• Solutions:
  • Worked with executive assistants, secretaries and stakeholders to set meetings and provide coverage to ensure participation of key stakeholders and bedside teams
  • Presentation on current rates of hypothermia, evidence-based literature on adverse effects of hypothermia, hospital costs related to hypothermia, and proposed recommendations. Support from senior leadership.
  • Worked with educators for each department to present guidelines to staff. Worked with the medical director of anesthesia to provide education for CRNAs and anesthesiologists. Presented at the Pediatric Surgical Process Improvement and Patient Safety Committee.

Links to published data (used to develop the protocol):[2][3]

Submitted by: Grant Geissler, MD

Additonal Implementers: Kirsten Yancy, RN, BSN, CPN

Recent Research

For recent research pertaining to the management of patients with spontaneous pneumothorax, please refer to references [4][5][6][7].

References