Re-audit of Multidisciplinary Management

Published Date: 19th July 2016

Publication Authors: Kuduvalli P

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Patients are at risk of hypothermia (core body temperature <36.0oC) during the perioperative pathway, due to the thermoregulatory response to anaesthetic drugs, which may cause physiological derangement and perioperative morbidity. In April 2008, NICE produced guidance for the management of inadvertent perioperative hypothermia (IPH). We aimed to re-assess our current practice within Whiston hospital with standards set by this NICE guidance, and to assess our practice since the first audit in April 2009.

Methods

Casenotes of all patients satisfying inclusion criteria were reviewed. Inclusion criteria - patients aged 16 years or older, having either a general anaesthetic and/or central neuroaxial blockage, and having surgery (excluding obstetric) at Whiston hospital between 7th February to 11th February 2011 inclusive.

Results

In total 142 patients were audited. All elective patients received preoperative information leaflets regarding the importance of temperature maintenance. Fifty-four per cent of patients were at high risk of developing IPH. No formal IPH assessment was documented, but all patients had each individual risk assessment parameter recorded. The majority of patients had temperature checked preoperatively (97%), and postoperatively on arrival to recovery (97%) and ward (98%). Hypothermia occurred in 18% preoperatively. No patients had their temperature checked immediately prior to induction; 21% had intraoperative temperature monitoring. Forced air warmers (FAW) were used in 58% of patients where NICE recommend their use. Hypothermia occurred in only 2% of patients in recovery, and in 10% of patients at some point during the 24 hour period postoperatively on the ward. Of the 77 patients who were at high risk of developing IPH, 60% received FAW, 18% had intraoperative temperature monitoring and only one was hypothermic on arrival to recovery (temperature 35.8oC).

Discussion

Advances have been made in our adherence to NICE guidelines since our first audit, though further improvements are required. Although risk assessment for IPH may not currently be formally recorded, all risk factors are reviewed. To aid IPH assessment documentation we are considering incorporating a specific ‘tick box’ for IPH risk assessment on the anaesthetic or preoperative checklist charts. Intraoperatively we encourage the use of FAW and ensure ambient theatre temperatures of at least 21oC. All healthcare professionals involved in perioperative care must be able to recognise and act upon the risk of IPH, which is training dependent. The majority of our patients were normothermic during their 24 hour perioperative journey and no serious adverse effects occurred due to any periods of hypothermia.

Jain, N; Kuduvalli, P. (2012).  Re-audit of multidisciplinary management to prevent inadvertent perioperative hypothermia during the patient's 24 hour perioperative journey . Anaesthesia. 67 (Supplement S1), 14.

 

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