Improving the recognition and management of inadvertent perioperative hypothermia

Background: Inadvertent perioperative hypothermia (IPH) is a common consequence of anaesthesia, defined as a core body temperature of <36.0°C.1 Adverse effects include surgical site infection, coagulopathy, pain, altered drug metabolism, and adverse cardiac events.1 Preventing IPH is a vital part of the enhanced recovery after surgery programme (ERAS).2 NICE clinical guideline (CG65) provides recommendations for avoiding IPH.3 Lancashire Teaching Hospitals falls below regional peers with regards to measuring and recording of temperature within an hour before surgical incision for elective hip and knee replacements. This quality improvement (QI) project aims to improve the recognition and management of IPH. Methods: Four QI cycles were carried out between 3 August 2021 and 1 December 2022, each including 20 patients undergoing hip, knee, and shoulder replacements. A retrospective case note review was carried out for each, with the proforma based closely on NICE CG65. QI methodology was used with initial interventions including a presentation to anaesthetic consultants at a departmental audit meeting, regular meetings with the theatre clinical manager, and creation and display of an educational poster in all theatres. Further changes included an email being sent to operating department practitioners to reinforce the importance of temperature measurement in the anaesthetic room and a trial of using a forced air warming device (FAWD) on all elective arthroplasty patients over a month. Results: At baseline it was found that pre-induction temperature was inconsistently recorded on the WHO checklist, with 0% of patients having temperature recorded on the anaesthetic chart. Some 25% of patients received an FAWD and 15% patients had a temperature of <36.0°C on arrival to recovery. There was no intraoperative IPH. By the end of the QI period there was an increase in recording of temperature on the anaesthetic chart from 0/20 to 7/20 patients. Use of FAWD increased from 5/20 to 11/20 (Fig. 3). Conclusion: Although positive change has been achieved, there is further room for improvement in the recording and documentation of temperature before induction, and in the use of FAWD. The prevalence of IPH in recovery remained stable between 10% and 20% despite improvements, therefore additional elements of perioperative care could also be addressed. Future steps involve ongoing team feedback and addressing compliance with fluid warming. 1.Riley C, Andrzejowski J. BJA Educ 2018; 18: 2272.Bernard H. Br J Nurs 2013; 22: 319–253.NICE. Perioperative hypothermia (inadvertent): the management of inadvertent perioperative hypothermia in adults, NICE Clinical Guideline 65, 2008. Available from www.nice.org.uk/guidance/cg65 (accessed 20/03/23)