hours and those that leave large areas of skin surface exposed: open
abdominal procedures, lateral hip revisions and anterior/posterior
spinal fusions.
The chart review revealed we had a patient warming problem. It
was most apparent in the OR, where 71% of initial and 46% of final
temperature readings were below 36°C. The results were better in the
PACU, where 11% of initial temperature readings didn't reach the tar-
get temperature for normothermia. Still, there was room for improve-
ment in how well we warmed recovering patients.
We had identified the issue, but how could we fix it? Our first step
was to take a closer look at our warming practices to determine how
we could continue keeping patients comfortable during their stay and,
more importantly, protect them from harm.
Studying the solution
Our pre-op nurses typically wrapped patients in warmed cotton blan-
kets, while our anesthesia providers applied upper- and lower-body
forced-air warming garments in the OR. We were curious to find out if
initiating active warming in pre-op would increase the number of nor-
mothermic temperature readings we'd record in the OR and PACU.
We conducted a 2-week trial to find out.
The trial focused on patients who were scheduled to undergo proce-
dures expected to last longer than an hour. We applied full-body,
forced-air warming gowns in pre-op. When patients were transferred
to the OR, staff folded the full-length warming gowns into upper- or
lower-body garments — the adjustable gowns are designed for that
purpose — depending on where the surgical site was located. Active
full-body warming continued in the PACU.
Patients who were pre-warmed arrived in PACU with an average nor-
mothermic temperature of 36.2°C, whereas those who were not pre-
3 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 9
