patients who underwent procedures lasting 60
minutes or longer under general or neuraxial
anesthesia were normothermic in the PACU —
below the 95% threshold.
• Analyze. After the team determined the extent
of the issue, they drilled down to its root causes.
Ms. Dowling-Schmitt says they reviewed 674
patient records to determine how staff were
recording patient temperatures and documenting
the readings. Were patients colder than they
should have been in the PACU because their core
temperatures were truly low or because tempera-
tures were documented incor-
rectly? "We had to understand
the underlying causes of the
issue to identify what improve-
ments needed to be made," says
Ms. Dowling-Schmitt.
She discovered the center's
flow sheet had only a single
space for staff to record a
patient's temperature. Nurses
could jot down a patient's initial
temperature reading, but had no
place to note remeasurements
after warming interventions
were applied.
"We also realized the forehead
monitoring strips staff used meas-
ured temperatures in two-degree
increments," says Ms. Dowling-
Schmitt. "They were useful for
recognizing large temperature
swings, which could indicate the
onset of malignant hyperthermia,
but they didn't provide the accu-
racy needed for a quality report-
ing metric."
The quality improvement proj-
ect revealed staff used both
Fahrenheit and Celsius readings
to record and document patients'
temperatures. The lack of stan-
dardization created confusion
among members of the care
team, who didn't always know
how to convert one temperature
scale to the other and therefore
weren't clear on when to apply
active warming methods to
hypothermic patients.
Additionally, the surgery
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YOU
WOULDN'T
WANT THIS
IN YOUR
OPERATING
ROOM
IMAGINE
EFFECTIVE PATIENT
WARMING WITH:
NO
NOISE
NO AIR MOVEMENT
NO EXCESSIVE HEAT
