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.

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.

Based on the review of literature, hypothermia is a devastating and unwanted side effect of general anesthesia. The side effects of hypothermia increases the incidences of drug metabolism, wound infections, pressure ulcers, coagulation function abnormalities, and cardiac morbidity. Hypothermia is defined as a core body temperature of less than 36 degrees Celsius. This kind of hypothermia is common in the general surgery patients, but studies suggest that this may be prevented by pre-warming with forced warm air pre-operatively. Several studies found that pre-warming is a low-cost intervention that can decrease on unwanted hospital stays and poor patient outcomes. This research paper hopes to answer the PICOT question: In preoperative adult patients (P) does pre-warming before surgery (I) compared to not pre-warming before surgery (C) prevent hypothermia (O) during the recovery period (T)?

Based on literature reviews, as many as 70 percent of surgical patients develop hypothermia during the perioperative experience. Documented studies demonstrate the association of hypothermia with many significant complications. Hypothermia can begin in the preoperative phase shortly after admission to the preoperative department. Actively warming the preoperative patient for 30 to 60 minutes can decrease the temperature gradient between the periphery and the core and maintain equilibrium of the patient. Decreasing the temperature gradient during the preoperative phase leads to less heat loss during the operative phase. Neuman's systems model of nursing theory exemplifies the importance of prevention in the management and avoidance of stressors to the patient system. Minimizing stressors helps to maintain optimal equilibrium and wellness. The simple and inexpensive nursing intervention of active preoperative warming has been shown to decrease hypothermia during the operative and post anesthesia phases of surgery. Active warming decreases surgical complications, improves patient outcomes, and decreases health care costs. It is also shown to increase patient comfort and decrease anxiety. Considering Neuman's theory, the benefit of comfort and decreased anxiety also leads to equilibrium and better outcomes. Current practices of passive, courteous warming should be changed to intentional interventional warming for the purpose of hypothermia prevention. Standardized preoperative care that includes active warming can improve patient outcomes by decreasing the associated complications of hypothermia.

Assesses the use of preoperative forced-air warming and its effects on minimizing inadvertent perioperative hypothermia. Six studies were analyzed. Forced-air prewarming of patients undergoing surgery helped to minimize inadvertent perioperative hypothermia in adult surgical patients undergoing general anesthesia.

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.

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.