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

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.

Prepare for success on certification exams and in perioperative nursing! Alexander’s Care of the Patient in Surgery, 16th Edition is the definitive text for nurses and surgical technologists training for a career in the operating room. Illustrated, step-by-step instructions cover patient care in more than 400 surgical interventions, including positioning, instrumentation, and postoperative care. New to this edition is additional coverage of robotic surgery, along with review of evidence-based guidelines for practice. From well-known educator Jane C. Rothrock — and with every chapter authored by an expert nurse — Alexander’s gives you the tools you need to provide safe, high-quality care in the surgical setting. Over 400 general and specialty surgical interventions are covered, as well as many minimally invasive surgical procedures, whether performed in a hospital, outpatient clinic, or in a doctor's office. 900 full-color photos and illustrations show surgical anatomy, procedures, and methods. Comprehensive coverage includes basic perioperative nursing principles, such as patient and environmental safety, infection prevention and control, positioning, anesthesia and pain management, the unique needs of special populations such as pediatric and geriatric patients, and more. Comprehensive practice exams on the Evolve companion website include 300 exam-style questions with rationales. Perioperative nursing considerations include assessment, nursing diagnosis, outcome identification, planning, implementation, evaluation, discharge planning, and patient and family education. Sample plans of care include nursing diagnoses, outcomes, and interventions. Surgical Pharmacology tables summarize the drugs most commonly used for each surgical procedure, including generic and trade names, indications, and pharmacokinetics. Patient and Family Education boxes include specific guidelines for preprocedural and postprocedural care, side effects and complications, home care, discharge instructions, and psychosocial care. Patient Safety boxes highlight Joint Commission initiatives for patient and staff safety in the surgical setting. Best Practice and Research Highlight boxes apply the latest scientific research to patient care. Critical thinking questions at the end of each chapter let you assess your understanding of important material. NEW! Robotic-Assisted Surgery boxes highlight a rapidly expanding surgical modality. NEW! Enhanced Recovery After Surgery boxes promote review of protocols for early recovery for patients undergoing major surgery. NEW! Patient Engagement Exemplar boxes optimize surgical outcomes by addressing AORN guidelines on the issues of patient care and involvement of the patient’s family. NEW standards and AORN toolkits cover topics ranging from enhanced post-surgical recovery to prevention of pressure ulcers.

Completely revised to meet the demands of today’s trainee and practicing plastic surgeon, Aesthetic, Volume 2 of Plastic Surgery, 4th Edition, features new full-color clinical photos, dynamic videos, and authoritative coverage of hot topics in the field. Editor-narrated PowerPoint presentations offer a step-by-step audio-visual walkthrough of techniques and procedures in aesthetic surgery. Offers evidence-based advice from a diverse collection of experts to help you apply the very latest advances in aesthetic plastic surgery and ensure optimal outcomes. Provides updated coverage of: Facelift - The male patient; Energy-based devices for body contouring; Autologous gluteal flaps for augmentation and preservation of gluteal contour; Buttock shaping with fat grafting and liposuction; and Essential elements of patient safety in Aesthetic Plastic Surgery, just to name a few. New volume editor J. Peter Rubin brings his expertise and know-how to all aspects of aesthetic surgery.

Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies. But surgical site infections are not just a problem for poor countries. In the United States, they contribute to patients spending more than 400 000 extra days in hospital at a cost of an additional US $10 billion per year. No international evidence-based guidelines had previously been available before WHO launched its global guidelines on the prevention of surgical site infection on 3 November 2016, and there are inconsistencies in the interpretation of evidence and recommendations in existing national guidelines. These new WHO guidelines are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.

This practical text offers a comprehensive guide to perioperative temperature management for anaesthetists, surgeons and nurses. The physiological basics of thermoregulation and heat exchange are covered, before the changes that occur during general and regional anaesthesia are outlined. The relevant adverse scenarios associated with perioperative hypothermia, including morbid cardiac events, impairment of coagulation, increased blood loss and surgical site infections are discussed, before the methods of measuring core temperature and the equipment and techniques to keep patients warm are described. Richly illustrated and clearly structured for quick reference, Perioperative Temperature Management is an essential daily resource to help ensure safe, effective practice.