School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.
St Vincent's Private Hospital Sydney, Sydney, NSW, Australia.
J Clin Nurs. 2018 Mar;27(5-6):1239-1249. doi: 10.1111/jocn.14171. Epub 2018 Feb 1.
To improve the prevention, detection and treatment of perioperative inadvertent hypothermia in adult surgical patients by implementing a Thermal Care Bundle.
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: (i) assess risk; (ii) record temperature; and (iii) actively warm.
A pre- and postimplementation study was conducted to determine the impact of the Thermal Care Bundle on the prevention, detection and treatment of perioperative inadvertent hypothermia.
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.
Data from 729 patients (pre-implementation: n = 351; postimplementation: n = 378) at four sites were collected between December 2014-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 perioperative inadvertent hypothermia increased postimplementation.
The Thermal Care Bundle facilitated improved management of perioperative inadvertent hypothermia through increased risk assessment, temperature recording and active warming but did not impact on perioperative inadvertent hypothermia incidence. Increased temperature recording may have more accurately revealed the true extent of perioperative inadvertent hypothermia in this population.
This study showed that a collaborative, context specific implementation method, such as the IHI Breakthrough Series Model, is effective at improving practices, which can improve thermal care.
通过实施热护理包，提高成人手术患者围手术期意外低体温的预防、检测和治疗水平。
保持患者围手术期体温正常可预防不良手术结果。低体温可导致严重并发症，包括手术出血风险增加、手术部位感染和心脏不良事件。热护理包由三个要素组成：（i）评估风险；（ii）记录体温；（iii）主动升温。
进行了一项实施前和实施后的研究，以确定热护理包对预防、检测和治疗围手术期意外低体温的影响。
使用改进版的医疗保健改善研究所突破系列合作模式来实施热护理包。数据是从审核病历中收集的。
2014 年 12 月至 2016 年 1 月，在四个地点共收集了 729 名患者（实施前：n=351；实施后：n=378）的数据。记录到风险评估患者的百分比、每个围手术期阶段至少有一次记录的体温、以及适当的主动升温都有所改善。尽管如此，围手术期意外低体温的总体发生率在实施后增加。
热护理包通过增加风险评估、体温记录和主动升温，促进了围手术期意外低体温的管理，但并未影响围手术期意外低体温的发生率。体温记录的增加可能更准确地揭示了该人群中围手术期意外低体温的真实程度。
本研究表明，类似 IHI 突破系列模型的协作、特定于背景的实施方法对于改进实践是有效的，这可以改善热护理。
