Pre-operative warming to prevent hypothermia in Operating Theatre in PMH

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Authors (including presenting author) :
Kam MSS(1), Yau CM(1)
Affiliation :
(1)Operating Theatre & Theatre Services Centre,Princess Margaret Hospital
Introduction :
Pre-operative warming is applying heat in the pre-operative area before the patient goes to the OR with goal of achieving normal body temperature, so that patient diminishes the degree of vasodilation and redistribution of heat that occurs on the induction of anaesthesia. However, many perioperative clinicians encounter difficulty in preventing hypothermia in surgical patient. One intervention to prevent perioperative hypothermia is the use of forced-air warming. Although forced-air warming is used most frequently in the intra-operative area, pre-operative warming patient with forced-air warming systems before induction of anaesthesia may be enough to prevent hypothermia throughout the surgical procedure, allowing patients to arrive in the post-anaesthesia care unit in a normothermic state. A pilot program was launched in October 2018 in PMH.
Objectives :
1.To enhance nursing practice of prevent hypothermia by pre-operative warming. 2.To define the approach and framework of prevent hypothermia by pre-operative warming which specify the methods and time frame for pre-operative warming. 3.To standardize photo guide materials to facilitate an effective communication between nurses and supervisors.
Methodology :
In order to set up an evidence-based program to reduce postoperative hypothermia among patient undergoing lower GI operation by pre-operative forced warm air. Systematically review of the current literature is conducted to review the effectiveness of pre-operative warming on preventiion of postoperative hypothermia. Moreover, we would like to determine the transferability and feasibility in local setting. Briefing sessions are conducted to introduce the program and delineate the roles and responsibilities of nurses and supervisors. The program comprises of 4 steps: 1. Pre-planning stage: systemic literature review and synthesis of data. 2. Innovation: identify the target of audience, setting and staff. 3. Implementation plan: identifying the stakeholder, initiating and guiding the change. 4. Evaluation: Identifying the patient, healthcare provider and system outcomes.
Result & Outcome :
In the local setting, before implementing the program, there are 15 cases out of 85 cases of lower GI operation which developed hypothermia (17.64%). After implementation of the pilot study from October 2017 to February 2018, total 59 cases of lower GI operations are performed and no hypothermia case is reported. The result shows the effectiveness of pre-operative warming in maintaining normal post-operative body temperature of patient undergoes lower GI operation. On the other hand, the pilot study also shows there is no significant difference of post-operative hypothermia against the duration of preoperative force warm air (10-60 minutes). A task force is set up to further implement pre-operative warming to specialties.

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