Effect of a thermal care bundle on the prevention, detection and treatment of perioperative inadvertent hypothermia

Aims and Objectives:
To improve the prevention, detection, and treatment of perioperative inadvertent hypothermia (PIH) in adult surgical patients by implementing a Thermal Care Bundle.

Background:
Keeping patients normothermic perioperatively prevents adverse surgical outcomes. Hypothermia leads to serious complications including increased risk of surgical bleeding, surgical site infections, and morbid cardiac events. The Thermal Care Bundle consists of three elements: 1) assess risk; 2) record temperature; and (3) actively warm.

Design:
A pre-post implementation study was conducted to determine the impact of the Thermal Care Bundle on the prevention, detection and treatment of PIH.

Methods:
The Thermal Care Bundle was implemented using an adapted version of the Institute of Healthcare Improvement's Breakthrough Series Collaborative Model. Data were collected from auditing medical records.

Results:
Data from 729 patients (pre-implementation: n=351; post-implementation: n=378) at four sites were collected between December 2014 to January 2016. Improvements were recorded in the percentage of patients with a risk assessment; at least one documented temperature recording per perioperative stage; and appropriate active warming. Despite this, the overall incidence of PIH increased post-implementation.

Conclusion:
The Thermal Care Bundle facilitated improved management of PIH through increased risk assessment, temperature recording, and active warming but did not impact on PIH incidence. Increased temperature recording may have more accurately revealed the true extent of PIH in this population.