Introduction: The National Institute for Clinical Excellence (NICE) guideline on Inadvertent Perioperative Hypothermia was published in April 2008. Some of the recommendations were difficult to achieve but most were simple and required little extra expense. We therefore decided to audit patients' pre and postoperative temperatures before and after instituting as many of the recommendations as we practicably could.
Methods: 100 elective consecutive elective major orthopedic patients had their temperatures recorded as they arrived in the theatre suite and again when they arrived in recovery. Their age, ASA grading and whether a Bair Hugger hot air blanket was used in theatre was also recorded. Temperature was masured in the external auditory meatus using a Genius2 device. We then over the next 12 months implemented the following measures: making sure the patients remained adequately clothed on the ward until required in theatre, at least 2 blankets on the bed, always infusing warmed IV fluids, and always using a Bair Hugger hot air blanket. A further 100 consecutive patients were then audited. Ethical approval was waived because it was an audit of current practice.
Results: 1st audit: 91 patients were included. Preop mean temp was 36.1 (range 34.7-37.3) and mean postop was 35.4, a fall of 0.67 degrees C. (p< 0.001 Students paired t test). 36 patients had a preop temp. of < 36 (39%) and 74 patients had a postop temp of < 36 (81%) of whom 20 had a postop temp of < 35 (22%).2nd audit: 98 patients were included. Mean preop temp was 36.4 (range 35-37.5) and mean postop was 35.9, a fall of 0.44 degrees C. (p< 0.001 Students paired t test). 17 patients had a preop temp < 36 (17%) and 52 patients had a postop temp < 36 (53%) of whom only 4 had a temp < 35 (4%).
Discussion: By re-auditing a similar group of patients, we were able to show a small but significant reduction in temperature fall before and after surgery, following implementation of measures recommended by NICE.
Equally important was a culture change in the ward and theatre staff towards keeping patients warm. However we still fall short of the target set by the Patient Safety First Campaign which is 95% of patients arriving in theatre with a temp >36.0.
1.National Institute for Health and Clinical Excellence Guideline 65. Inadvertent perioperative hypothermia. April 2008
2.NICE and warm (Editorial) British Journal of Anaesthesia 2008; 101:293