The implementation of a standardized warming protocol aims to improve patient outcomes by preventing inadvertent perioperative hypothermia (IPH) and its complications in the ambulatory surgical setting. All patients, regardless of age or gender, are at risk for experiencing a 1-2° C drop in body core temperature within thirty minutes of anesthesia induction. The global aim of this project is to prevent IPH and its complications in the ambulatory surgical setting by implementing a warming protocol at a freestanding ambulatory surgery center. While an audit of the microsystem revealed a normothermia rate of 28%, a standardized warming protocol is expected to increase the normothermia rate to 90%. The project is vital because it reduces costs from postoperative complications, promotes best safe practices and quality care, and enhances the patient's surgical experience and satisfaction. Based on clinical best practice guidelines recommended by the National Institute for Health and Care Excellence and American Society of Perianesthesia Nursing, a temperature management policy and warming protocol were implemented. Staff was educated about IPH and its complications, and post-tests and follow-up meetings with each department were held to assess staff understanding. The project is currently an ongoing change, and evaluation of the results is expected to occur in December 2015. The nursing profession is constantly pressured to find innovative ways to improve patient care, eliminate waste, and maintain affordability through process improvement projects. A process improvement project, such as the warming protocol, is both essential and meaningful when adopted in the ambulatory surgery setting.

Problem: The nursing workforce is constantly motivated to find innovative ways to improve patient care, eliminate waste, and maintain affordability through process improvement projects. All surgical patients, regardless of age or gender, can experience a 1-2° C drop in body core temperature within an hour of anesthesia induction. This places the patient at a higher risk of developing inadvertent perioperative hypothermia (IPH), which can lead to adverse outcomes such as impaired wound healing, blood loss, postoperative pain, and respiratory distress. It is critical to prevent outcomes such as these from occurring in the ambulatory setting, as it affects patient satisfaction, delays healing, and increases the cost of care. Context: The implementation of a standardized warming protocol aims to address these issues by preventing IPH in the ambulatory surgical setting. While much research has studied best warming interventions, there is a great need for a standardized warming protocol that is customized to a high turnover environment such as ambulatory surgery and staff education about using the protocol. A needs assessment at the project's setting revealed a 68% normothermia rate. It was the goal of the project to reach a normothermia rate of 90%, as benchmarked by the Center of Medicare and Medicaid Services (CMS) quality metrics. Interventions: This project aimed to improve the normothermia rate by implementing the three following components at the clinical setting: staff education about IPH and its complications, standardization of a warming protocol based on best practice guidelines, and modification of the protocol using staff feedback. Measures: Qualitative data from staff responses were evaluated and categorized under the following themes: concerns, strengths, weaknesses, and recommendations. Any gaps or areas of improvement identified from the feedback survey were used to modify the protocol. Outcome measures to evaluate staff learning and identify knowledge deficiencies were achieved by administering a Pre and Post-Education Questionnaire. A comparison of anonymous, aggregated scores were used to evaluate whether education was effective in increasing IPH knowledge. Results: The results of this project aligned with the project's goals, objectives, and conceptual framework. One result was to ensure that all patients receiving general or neuroaxial anesthesia received appropriate warming interventions and were normothermic in the postoperative phase of care, as evidenced by the monitored normothermic rate. In addition, the IPH education in-service and warming protocol instilled a standardized practice of care based on best practice guidelines, which was achieved through the Pre and Post-Education Questionnaires and Process Evaluation and Feedback Survey. At the end of this process improvement project, staff gained a deeper understanding of IPH and practiced effective thermal management techniques to improve overall improve patient safety. Conclusion: When a warming protocol is implemented into nursing practice, the impact can be profound, as it is directly related to improving patient outcomes, eliminating unnecessary cost, and cultivating quality of care. The adoption of a warming protocol standardized nursing practice utilizing warming interventions based on best practice guidelines.

Inadvertent hypothermia is a common and preventable issue among surgical patients. This paper will describe the problem and provide research data to support the proposed solution. The problem asks the question, in surgical patients; will the use of pre and intra operative core warming, as compared to the use of standard care to maintain normothermia, decrease the incidence of inadvertent postoperative hypothermia in the Post Anesthesia Recovery Unit? Research has proven that one to two hours of preoperative core warming will significantly reduce the incidence of inadvertent hypothermia. The prevention of inadvertent hypothermia is extremely important for surgical patients because hypothermia can cause serious poor outcomes related to surgery. Such poor outcomes include surgical site infection, delayed wound healing, increased surgical blood loss, cardiac events, and an increase in time spent in the PACU. All events associated with inadvertent hypothermia can cost the hospital large amounts of money as well as increase the time a patients stays at the hospital which effects patient satisfaction. The plan is to implement a preoperative core warming policy in addition to the standard of care intraoperative hypothermia prevention policy. The change will use evidence based research to support the use of forced-air warming machines in the preoperative department. The preoperative staff will also receive education on assessing for inadvertent hypothermia risks. The intraoperative staff will also use forced-air warming machines to maintain normothermia as well as monitor the patient's core temperature. The PACU staff will document the patient's core temperature immediately upon arrival. These protocols will significantly reduce the events of inadvertent hypothermia and provide better outcomes for surgical patients as well as reduce hospital costs and increase patient satisfaction.

Inadvertent Perioperative Hypothermia (IPH) is defined as a patient's core body temperature unintentionally dropping below 36°C at any point in the perioperative environment. IPH occurs most frequently in the first hour after induction of general anesthesia secondary to vasodilation and heat transfer from the patient's core to the periphery. Despite well-known detrimental intraoperative and postoperative outcomes associated with IPH, it continues to occur in approximately half of all surgical patients. Literature reviews reveal that promotion of normothermia throughout the perioperative environment reduces the incidence of complications of IPH, improves patient outcomes, and lowers health care costs. Current preoperative practice is to monitor a patient's temperature only once on admission and subsequently deploy passive warming interventions with no further monitoring. Ensuring that patients are appropriately monitored and actively warmed preoperatively has been identified as a strategy to reduce the incidence of IPH both intraoperatively and postoperatively due to maintenance of peripheral temperature and limiting of heat-transfer following general anesthetic onset. As Orem's Self-Care Deficit Theory maintains the nursing role in purposefully assisting patients to meet their self-care needs, known and unknown, actively ensuring euthermia in the preoperative environment promotes optimal outcomes in surgical patients and aligns nurses with the priorities of patient care and patient advocacy. Active intraoperative warming is effective but frequently insufficient to prevent the occurrence of IPH alone. A standardized, intentional preoperative warming strategy which includes continual patient temperature monitoring and purposeful intervention will reduce the incidence of IPH and associated complications.

It is said that anywhere between 60% and 90% of surgical patients will become hypothermic(Hegarty and others, 2009). This paper will discuss this problem, as well as the nursing theory behind the proposal. Research for the proposal is based on the PICOT question: In adult surgical patients, will pre-warming the patient at least 15 minutes prior to induction of anesthesia, compared to only intraoperative warming, result in decreased incidence of perioperative hypothermia within the first two hours following surgery? Pre-operative warming of surgical patients for at least 30 minutes by means of forced air will be proposed to the nurse leaders, administration, and stakeholders at Tallahassee Memorial Hospital. The fifteen research articles sound in the CINAHL database show there are a multitude of factors that contribute to the occurrence of hypothermia as well as preventing it. This paper provides evidence the preoperative warming with a forced-air warmer, in addition to intraoperative warming on adult surgical patients helps in maintaining normothermia. Preoperative warming is safe, tolerated well, and increases patient satisfaction. Maintaining normothermia throughout all surgical phases will decrease healthcare costs to hospitals and patients. Implementing this proposal will not only prevent inadvertent hypothermia, but increase patient satisfaction, and lower costs to the hospital and patient.

Purpose: Unintentional hypothermia is defined as a core body temperature below 36u00b0C. The most frequent warming protocols in major surgeries and/or surgeries lasting more than 60 minutes are active warming methods initialized be the anesthesia team. The goal of this study was to evaluate the adherence to a protocol initiating forced-air warming by the nursing staff in the operating rooms during the immediate preoperative period. We also to assessed the effects of different pre-warming times on intraoperative temperatures, specifically redistribution hypothermia due to induction of anesthesia. Method: The study was conducted in a surgery center and comprised the development of the pre-warming protocol, training of the nursing staff and data collection in April and May of 2015. Oral thermometers were used for up to 50 minutes during the pre-anesthesia period (depending on length of pre-warming) and esophageal temperatures were measured every 30 minutes throughout anesthesia (starting with intubation). Descriptive analyses of demographic data, core temperatures and types of forced-air warming devices were conducted. We also compared core temperatures at 60 minutes after induction. ANOVA and Tukeyu2019s test were used to analyze the core temperatures of the groups. Significant differences were considered significant when p