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

Duff, Jed and Walker, Kim and Edward, Karen-Leigh and Ralph, Nicholas and Giandinoto, Jo-Anne and Alexander, Kimberly and Gow, Jeff and Stephenson, John (2018) Effect of a thermal care bundle on the prevention, detection and treatment of perioperative inadvertent hypothermia. Journal of Clinical Nursing. ISSN 0962-1067

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.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Published online 1 Feb 2018. Permanent restricted access to ArticleFirst version, in accordance with the copyright policy of the publisher.
Faculty / Department / School: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery
Date Deposited: 19 Feb 2018 04:32
Last Modified: 14 May 2018 02:00
Fields of Research : 11 Medical and Health Sciences > 1110 Nursing > 111003 Clinical Nursing: Secondary (Acute Care)
11 Medical and Health Sciences > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified
Funding Details:
Identification Number or DOI: 10.1111/jocn.14171
URI: http://eprints.usq.edu.au/id/eprint/33432

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