Implementation of a Warming Intervention Protocol to Prevent Inadvertent Perioperative Hypothermia in the Ambulatory Surgical Setting

Problem: The nursing workforce is constantly motivated to find innovative ways to improve patient care, eliminate waste, and maintain affordability through process improvement projects. All surgical patients, regardless of age or gender, can experience a 1-2° C drop in body core temperature within an hour of anesthesia induction. This places the patient at a higher risk of developing inadvertent perioperative hypothermia (IPH), which can lead to adverse outcomes such as impaired wound healing, blood loss, postoperative pain, and respiratory distress. It is critical to prevent outcomes such as these from occurring in the ambulatory setting, as it affects patient satisfaction, delays healing, and increases the cost of care. Context: The implementation of a standardized warming protocol aims to address these issues by preventing IPH in the ambulatory surgical setting. While much research has studied best warming interventions, there is a great need for a standardized warming protocol that is customized to a high turnover environment such as ambulatory surgery and staff education about using the protocol. A needs assessment at the project’s setting revealed a 68% normothermia rate. It was the goal of the project to reach a normothermia rate of 90%, as benchmarked by the Center of Medicare and Medicaid Services (CMS) quality metrics. Interventions: This project aimed to improve the normothermia rate by implementing the three following components at the clinical setting: staff education about IPH and its complications, standardization of a warming protocol based on best practice guidelines, and modification of the protocol using staff feedback. Measures: Qualitative data from staff responses were evaluated and categorized under the following themes: concerns, strengths, weaknesses, and recommendations. Any gaps or areas of improvement identified from the feedback survey were used to modify the protocol. Outcome measures to evaluate staff learning and identify knowledge deficiencies were achieved by administering a Pre and Post-Education Questionnaire. A comparison of anonymous, aggregated scores were used to evaluate whether education was effective in increasing IPH knowledge. Results: The results of this project aligned with the project’s goals, objectives, and conceptual framework. One result was to ensure that all patients receiving general or neuroaxial anesthesia received appropriate warming interventions and were normothermic in the postoperative phase of care, as evidenced by the monitored normothermic rate. In addition, the IPH education in-service and warming protocol instilled a standardized practice of care based on best practice guidelines, which was achieved through the Pre and Post-Education Questionnaires and Process Evaluation and Feedback Survey. At the end of this process improvement project, staff gained a deeper understanding of IPH and practiced effective thermal management techniques to improve overall improve patient safety. Conclusion: When a warming protocol is implemented into nursing practice, the impact can be profound, as it is directly related to improving patient outcomes, eliminating unnecessary cost, and cultivating quality of care. The adoption of a warming protocol standardized nursing practice utilizing warming interventions based on best practice guidelines