Page 129 - Hospital Authority Convention 2018

Service Enhancement Presentations

F3.2 Clinical Safety and Quality Services I 14:30 Room 421

Maintenance of Normothermia during Surgery
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Kwok V , Leung H , Fu MF , Mao KF , Chim TL , Ng YY , Yip WP , Wong LM 2
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Department of Anaesthesia and Intensive Care, Operating Theatre, Pok Oi Hospital, Hong Kong
Introduction HOSPITAL AUTHORITY CONVENTION 2018
Inadvertent perioperative hypothermia is a common surgical complication and is defined as core body temperature below
36˚C. Hypothermia may increaseinfections, bleeding, the need for transfusion and cardiac complication. It is estimated that
70-90% of patients will experience hypothermia during the first hour of operation (Bayter-Marn, Rubio, Valedn, Macas, 2017).
It is because anaesthesia impairs central thermoregulation, allowing re-distribution of body heat. In the Operating Theatre
of Pok Oi Hospital, there was 38.8% hypothermia rate post-operatively from October 2015 to March 2016. High risk cases
include patients under regional anaesthesia with short operation time and there is no temperature monitoring during surgery;
urological surgery with continuous irrigation during surgery and old age patients undergoing hip surgery. Hence, a project
team was established to identify the reasons of high hypothermia rate, formulate the improvement task and evaluate the
outcome accordingly.
Objectives
(1) To deliver safe and quality care to patients who undergo general /regional anaesthesia by prevention of hypothermia; (2)
to review the causes of these hypothermia cases and check if current alternatives preventing hypothermia are effective; (3)
to increase staff awareness about the importance of maintenance of normothermia perioperatively; and (4) to evaluate the
project outcome.

Methodology
A series of improvement tasks were formulated. Patients’ temperature is checked upon arrival to operation theatre; a warm Monday, 7 May 2018
blanket is provided to all patients while waiting for operation in induction room; active pre-warming is applied to patients if
their on-call temperature is below 36°C or requested by anaesthetists; theatre temperature is set between 20°C - 22°C to
reduce heat loss by convection and radiation; thermometers are available inside theatre to facilitate temperature monitoring
of regional anaesthesia.

One of the main practical changes is to start active warming of patients before induction. Then patient’s body is refrained
from exposure to environment during the first 5-10 minutes of anaesthesia induction. It is used to prevent a patient’s body
temperature from dropping sharply during the first hour of operation. Staff was educated about the new measurement. The
hypothermia rate is then evaluated periodically.

Results
Hypothermia rate is reduced sharply from 38.8% to 2.85% from March 2016 to September 2017.

The programme can enhance awareness and knowledge about hypothermia management of staff. The measurements can
improve effectiveness, efficiency of nursing care and ensure early detection of high risk cases of hypothermia during surgery.
Proper thermal management may reduce complications and improve outcome in high-risk surgical patients.

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