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Oden TN, Celikturk Doruker N, Demir Korkmaz F. Perioperative Health Care Professionals' Knowledge of Evidence-Based Inadvertent Perioperative Hypothermia Management. J Perianesth Nurs 2024; 39:789-794. [PMID: 38520469 DOI: 10.1016/j.jopan.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 03/25/2024]
Abstract
PURPOSE To evaluate the perioperative health care professionals' knowledge of evidence-based inadvertent perioperative hypothermia management. DESIGN A descriptive, cross-sectional study. METHODS The research sample consisted of 219 perioperative nurses and anesthesia technicians working in the university hospital and participating in perioperative care. Data were collected by the researchers using a questionnaire that included descriptive characteristics of health care professionals and inadvertent perioperative hypothermia management between March and April 2021. Descriptive statistics, Shapiro-Wilk normality, Kruskal Wallis, Mann Whitney U, and Spearman correlation test were used to analyze the data. FINDINGS In this study, only 29.2% of the health care professionals knew that the threshold value for inadvertent perioperative hypothermia was <36 °C. The mean knowledge score of health care professionals on the management of inadvertent perioperative hypothermia was 13.78 ± 3.47. The knowledge score of 79.5% of health care professionals was moderate level. A significant correlation was determined between inadvertent perioperative hypothermia management knowledge score and education status (P = .032), task (P < .001), and mean years in the profession (P = .02). CONCLUSIONS The knowledge of the health care professionals working in the perioperative process about evidence-based practices related to inadvertent perioperative hypothermia management was determined to be moderate. We recommend increasing the level of knowledge of health care professionals by providing education on guidelines regarding inadvertent perioperative hypothermia management.
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Affiliation(s)
- Tugba N Oden
- Department of Organ Transplantation Center, Ege University Hospital, Izmir, Turkey.
| | | | - Fatma Demir Korkmaz
- Department of Surgical Nursing, Ege University Faculty of Nursing, Izmir, Turkey
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Durmaz M, Yüksel S, Kural ŞK. Inadvertent Hypothermia in the Perspective of Operating Room Nurses: A Phenomenological Qualitative Study. J Perianesth Nurs 2024; 39:645-651. [PMID: 38300196 DOI: 10.1016/j.jopan.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE The aim of the study was to reveal the awareness and perceptions of operating room nurses concerning inadvertent hypothermia, as well as their experiences and recommendations for its prevention. DESIGN The study employed a phenomenological qualitative approach. METHODS This study was conducted with 17 nurses working in the operating room of a university hospital in Konya, Turkey. Data were collected face to face between 15 August and 30 September 2022 using the in-depth individual interview method. The data were subjected to inductive content analysis. Written permission was obtained from the hospital, the ethics committee, and the participants to conduct the study. FINDINGS The mean age of the nurses was 28.4 years and the majority were female. The nurses were graduates of a four-year health vocational high school, a two-year nursing associate degree program, or a four-year nursing bachelors' degree program. Their operating room experience ranged from 1 to 22 years. All the nurses were aware of inadvertent hypothermia, and all but one encountered hypothermia and applied preventive measures. The data analysis revealed 263 codes, 12 categories, and 4 themes on the awareness and perceptions of operating room nurses about inadvertent hypothermia and their experiences and recommendations for its prevention. CONCLUSIONS The findings showed that the majority of the participants were aware of inadvertent hypothermia and its risk factors, and frequently encountered inadvertent hypothermia despite implementing preventive measures.
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Affiliation(s)
- Melike Durmaz
- Department of Surgical Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
| | - Serpil Yüksel
- Department of Surgical Nursing, Division of Nursing, Faculty of Nursing, Necmettin Erbakan University, Konya, Turkey.
| | - Şerife K Kural
- Department of Nursing, Faculty of Health Sciences, Alanya Alaaddin Keykubat University, Alanya, Turkey
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Heidke P, Duff J, Keogh S, Munday J. Barriers and facilitators to evidence-based perioperative hypothermia management for orthopaedic patients: A systematic review. J Clin Nurs 2024; 33:3329-3354. [PMID: 39020519 DOI: 10.1111/jocn.17338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 04/30/2024] [Accepted: 06/03/2024] [Indexed: 07/19/2024]
Abstract
AIM To assess barriers and facilitators to the implementation of guidelines for the prevention of inadvertent perioperative hypothermia in orthopaedic patients. DESIGN Systematic review. DATA SOURCES Nine databases: PubMed, Embase, CINAHL, Cochrane CENTRAL, PsycINFO, ProQuest Dissertations and Theses, Scopus, Web of Science and Trip Clinical Evidence Database. METHODS Primary studies published in English between January 2008 to July 2022 were screened. Study selection, quality assessment, and data extraction were completed independently by researchers. Data were extracted using the Consolidated Framework for Implementation Research and mapped to the Expert Recommendations for Implementing Change strategies. RESULTS Eighty-seven studies were included in the review. The most frequently reported barriers and facilitators related to evidence strength, relative advantage, and cost of implementing perioperative hypothermia prevention guidelines. The top four ERIC strategies were: Identify and prepare champions; Conduct educational meetings; Assess for readiness and identify barriers and facilitators; and Inform local opinion leaders. CONCLUSION This review provides synthesized evidence regarding barriers and facilitators to perioperative hypothermia guidelines for patients undergoing orthopaedic surgery. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Our work provides theory guided strategies to promote implementation of perioperative hypothermia prevention to assist nurses caring for patients undergoing orthopaedic surgery. IMPACT Findings provide professionals caring for patients undergoing orthopaedic surgery with theory-informed strategies to improve perioperative hypothermia prevention. Reducing perioperative hypothermia will improve outcomes for patients undergoing orthopaedic surgery. REPORTING METHOD The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. NO PATIENT OR PUBLIC CONSULTATION Due to the study design, no patient or public consultation took place.
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Affiliation(s)
- Penny Heidke
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
- Central Queensland University, Brisbane, Queensland, Australia
| | - Jed Duff
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
- Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Samantha Keogh
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
- Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Judy Munday
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
- Royal Brisbane and Women's Hospital, Nursing and Midwifery Research Centre, Herston, Queensland, Australia
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Yilmaz Eker P, Topal Hançer A, Yilmaz M. The Development of the Inadvertent Perioperative Hypothermia Knowledge Test (IPH-KT). J Perianesth Nurs 2024; 39:433-438. [PMID: 38032568 DOI: 10.1016/j.jopan.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 09/01/2023] [Accepted: 09/14/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE This study aimed to develop the inadvertent perioperative hypothermia knowledge test (IPH-KT) for health care professionals and examine its validity and reliability. DESIGN The methodological and cross-sectional study design was used. METHODS The research was carried out with 326 nursing students in Turkey. Data for the study were collected using a demographic information form and the IPH-KT. FINDINGS The item difficulty index and item distinctiveness index of the questions included in the draft form of the 25-item test ranged from 0.03 to 0.81 and from 0.25 to 0.99, respectively. After the analyses, 8 items were excluded from the draft test, and the final version of the test consisted of 17 questions. The item difficulty index of the final test ranged from 0.30 to 0.96, and the item distinctiveness index ranged from 0.33 to 0.81. The reliability of the test was determined using the Kuder-Richardson formula 20 and found to be 0.72, indicating high internal consistency. Therefore, the IPH-KT was accepted as a reliable test. CONCLUSIONS The study revealed that the questions in the IPH-KT had varying difficulty levels and a high ability to discriminate between individuals with knowledge of IPH and those without. The results demonstrated that the test had good content and face validity and showed high reliability for measuring the IPH knowledge of nursing students.
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Affiliation(s)
- Pinar Yilmaz Eker
- Susehri Health College, Department of Nursing, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Ayse Topal Hançer
- Faculty of Health Sciences, Department of Nursing, Sivas Cumhuriyet University, Sivas, Turkey
| | - Meryem Yilmaz
- Faculty of Health Sciences, Department of Nursing, Sivas Cumhuriyet University, Sivas, Turkey
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Nascimento ASD, Lemos CDS, Biachi FB, Lyra FRSD, Gnatta JR, Poveda VDB. Evaluation of different body temperature measurement methods for patients in the intraoperative period. Rev Lat Am Enfermagem 2024; 32:e4143. [PMID: 38655937 DOI: 10.1590/1518-8345.6873.4143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/01/2023] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES this study aimed at estimating and comparing the reliability of temperature measurements obtained using a peripheral infrared temporal thermometer, a central cutaneous thermometer ("Zero-Heat-Flux Cutaneous thermometer") and an esophageal or nasopharyngeal thermometer among elective surgical patients in the intraoperative period. METHOD a longitudinal study with repeated measures carried out by convenience sampling of 99 patients, aged at least 18 years old, undergoing elective abdominal cancer surgeries, with anesthesia lasting at least one hour, with each patient having their temperature measured by all three methods. RESULTS the intraclass correlation coefficient showed a low correlation between the measurements using the peripheral temporal thermometer and the central cutaneous (0.0324) and esophageal/nasopharyngeal (-0.138) thermometers. There was a high correlation (0.744) between the central thermometers evaluated. CONCLUSION the data from the current study do not recommend using infrared temporal thermometers as a strategy for measuring the body temperature of patients undergoing anesthetic-surgical procedures. Central cutaneous thermometers and esophageal/nasopharyngeal thermometers are equivalent for detecting intraoperative hypothermia.
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Affiliation(s)
- Ariane Souza do Nascimento
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Cassiane de Santana Lemos
- Universidade Estadual de São Paulo Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
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Abuzied Y, Deeb A, AlAnizy L, Al-Amer R, AlSheef M. Improving Venous Thromboembolism Prophylaxis Through Service Integration, Policy Enhancement, and Health Informatics. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:22-27. [PMID: 38406656 PMCID: PMC10887485 DOI: 10.36401/jqsh-23-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/28/2023] [Accepted: 12/05/2023] [Indexed: 02/27/2024]
Abstract
Introduction Venous thromboembolism (VTE) prevention and management are susceptible issues that require specific rules to sustain and oversee their functioning, as preventing VTE is a vital patient safety priority. This paper aims to investigate and provide recommendations for VTE assessment and reassessment through policy enhancement and development. Methods We reviewed different papers and policies to propose recommendations and theme analysis for policy modifications and enhancements to improve VTE prophylaxis and management. Results Recommendations were set to enhance the overall work of VTE prophylaxis, where the current VTE protocols and policies must ensure high levels of patient safety and satisfaction. The recommendations included working through a well-organized multidisciplinary team and staff engagement to support and enhance VTE's work. Nurses', pharmacists', and physical therapists' involvement in setting up the plan and prevention is the way to share the knowledge and paradigm of experience to standardize the management. Promoting policies regarding VTE prophylaxis assessment and reassessment using electronic modules as a part of the digital health process was proposed. A deep understanding of the underlying issues and the incorporation of generic policy recommendations were set. Conclusion This article presents recommendations for stakeholders, social media platforms, and healthcare practitioners to enhance VTE prophylaxis and management.
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Affiliation(s)
- Yacoub Abuzied
- Nursing Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad Deeb
- Faculty of Nursing, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Layla AlAnizy
- Pharmacy Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Mohammed AlSheef
- Internal Medicine and Thrombosis, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Yilmaz Eker P, Yilmaz M. The Effect of Using a Normothermia Checklist on Awakening Time From Anesthesia and Coagulation Disorder: A Randomized Controlled Trial. J Nurs Res 2023; 31:e302. [PMID: 38015120 DOI: 10.1097/jnr.0000000000000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Inadvertent perioperative hypothermia (IPH) is a common issue in surgical patients. To avoid this issue, the patient should be monitored continuously throughout the perioperative process. Evidence-based practices in line with relevant guidelines are necessary to maintain normothermia. PURPOSE This study was developed to determine the effect of using a control list developed for preventing IPH on time of awakening from anesthesia and coagulation disorder in surgical patients. METHODS In this randomized controlled study, nursing interventions were applied to patients in accordance with the normothermia checklist (NC) developed by the researchers to prevent IPH. RESULTS In this study, 30 patients were respectively assigned to the experimental and control groups. Conducting nursing interventions in accordance with the control checklist was found to be effective in preventing IPH. Moreover, time of awakening from anesthesia was significantly shorter in the experimental group (3.77 ± 1.10 minutes) than the control group (11.03 ± 2.51 minutes; p < .05). Furthermore, tendency to bleed was higher in the control group than the experimental group, and a statistically significant between-group difference in coagulation disorders was found ( p < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE The results of this evidence-based study indicate that implementing nursing interventions in line with the developed NC is effective in preventing IPH. Preventing IPH, which increases the risk of numerous complications in surgical patients, is an important responsibility of nurses. Nurses may employ the NC proposed in this study to better secure the safety and minimize the risk of complications in surgical patients.
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Affiliation(s)
- Pinar Yilmaz Eker
- PhD, RN, Assistant Professor, Department of Nursing, Health College, Sivas Cumhuriyet University, Sivas, Turkey
| | - Meryem Yilmaz
- PhD, RN, Professor, Faculty of Health Sciences, Department of Nursing, Sivas Cumhuriyet University, Sivas, Turkey
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Liu QY, You TY, Zhang DY, Wang J. Clinical application of multidisciplinary team- and evidence-based practice project in gynecological patients with perioperative hypothermia. World J Psychiatry 2023; 13:848-861. [DOI: 10.5498/wjp.v13.i11.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Perioperative hypothermia (PH) negatively affects the physical and mental health of patients to varying degrees. Currently, there is no effective multidisciplinary team (MDT) intervention for gynecological patients with PH.
AIM To apply the best evidence on the prevention and management of PH in gynecological patients, improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT- and evidence-based practice (EBP) projects on the psychological status and cognitive function of gynecological patients with PH.
METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts, the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting. Based on the evidence, the practice plan was developed, and the MDT intervention was carried out in the preoperative ward, the preoperative preparation room, the intraoperative operating room, the postanesthesia care unit, and the 24-hour postoperative gynecological ward through the EBP program. The incidence of hypothermia, the nurses’ awareness, the implementation rate of examination indicators, and the thermal comfort level, psychological status and cognitive function of patients were compared before and after the implementation of the program.
RESULTS The incidence of PH in gynecological patients decreased from 43.33% to 13.33% after the implementation of the scheme. The implementation rate of examination indicators 6-10, 12, 14, 16-18, 21, and 22 reached 100%, and that of other indicators was above 90%, except for examination indicators 5 and 13, which was 66.67%; the indices were significantly improved compared with the baseline (before evidence application) (P < 0.05). The score of nurses' awareness of PH prevention and management in gynecological patients increased from 60.96 ± 9.70 to 88.08 ± 8.96, and the difference was statistically significant (P < 0.001). The total score of the perioperative thermal comfort level of patients undergoing gynecological surgery was 27.97 ± 2.04, which was significantly increased compared with the score of 21.27 ± 1.57 observed by researchers at baseline (P < 0.001). The perioperative Hamilton Depression Scale and Hamilton Anxiety Scale scores of patients undergoing gynecological surgery decreased from 15.03 ± 3.16 and 13.93 ± 2.64 to 4.30 ± 1.15 and 3.53 ± 0.78, respectively, with statistically significant differences (P < 0.001). The perioperative Montreal Cognitive Assessment Scale score of the gynecological surgery patients increased from 23.17 ± 1.68 to 26.93 ± 1.11, also with statistical significance (P < 0.001).
CONCLUSION MDT-based EBP for PH prevention and management in gynecological patients during the perioperative period can standardize nursing operations, improve nurses' awareness and behavioral compliance with gynecological hypothermia management, and reduce the occurrence of PH in gynecological patients while playing a positive role in reducing patients’ negative emotions and enhancing their cognitive function.
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Affiliation(s)
- Qing-Yan Liu
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Tong-Yang You
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Dai-Ying Zhang
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Juan Wang
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Munday J, Duff J, Wood FM, Sturgess D, Ralph N, Ramis MA. Perioperative hypothermia prevention: development of simple principles and practice recommendations using a multidisciplinary consensus-based approach. BMJ Open 2023; 13:e077472. [PMID: 37963694 PMCID: PMC10649611 DOI: 10.1136/bmjopen-2023-077472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES To develop a consensus on evidence-based principles and recommendations for perioperative hypothermia prevention in the Australian context. DESIGN This study was informed by CAN-IMPLEMENT using the ADAPTE process: (1) formation of a multidisciplinary development team; (2) systematic search process identifying existing guidance for perioperative hypothermia prevention; (3) appraisal using the AGREE II Rigor of Development domain; (4) extraction of recommendations from guidelines meeting a quality threshold using the AGREE-REX tool; (5) review of draft principles and recommendations by multidisciplinary clinicians nationally and (6) subsequent round of discussion, drafting, reflection and revision by the original panel member team. SETTING Australian perioperative departments. PARTICIPANTS Registered nurses, anaesthetists, surgeons and anaesthetic allied health practitioners. RESULTS A total of 23 papers (12 guidelines, 6 evidence summaries, 3 standards, 1 best practice sheet and 1 evidence-based bundle) formed the evidence base. After evidence synthesis and development of draft recommendations, 219 perioperative clinicians provided feedback. Following refinement, three simple principles for perioperative hypothermia prevention were developed with supporting practice recommendations: (1) actively monitor core temperature for all patients at all times; (2) warm actively to keep body temperature above 36°C and patients comfortable and (3) minimise exposure to cold at all stages of perioperative care. CONCLUSION This consensus process has generated principles and practice recommendations for hypothermia prevention that are ready for implementation with local adaptation. Further evaluation will be undertaken in a large-scale implementation trial across Australian hospitals.
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Affiliation(s)
- Judy Munday
- School of Nursing/Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Faculty of Health and Sports Sciences, University of Agder, Grimstad, Vest-Agder, Norway
| | - Jed Duff
- School of Nursing/Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Fiona M Wood
- School of Surgery, Burn Injury Research Unit, The University of Western Australia, Perth, Western Australia, Australia
- Department of Health Government of Western Australia, Royal Perth and Princess Margaret Hospitals, Perth, Western Australia, Australia
| | - David Sturgess
- Department of Anaesthetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Nicholas Ralph
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Mary-Anne Ramis
- School of Nursing/Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Evidence In Practice Unit, Mater Health Services Brisbane, South Brisbane, Queensland, Australia
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Chen F, Lian A. Applying Adult Learning Theory in Improving Knowledge, Attitude, and Practice of Inadvertent Perioperative Hypothermia in Operating Room Nurses: Single-Group "Before and After Study". Ther Hypothermia Temp Manag 2023. [PMID: 37948541 DOI: 10.1089/ther.2023.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
The study aimed to explore the effect of the training scheme guided by Knowles' adult learning theory model on perioperative hypothermia prevention-related knowledge, practice, and behavior in operating room nurses. Operating room nurses of a teaching hospital were included from February to May 2023. Under the guideline of the adult learning theory, we accessed the score of the knowledge, attitude, and practice in operating room nurses about the prevention of the inadvertent perioperative hypothermia (IPH) before and after trainings through qualitative interviews and questionnaire surveys. There were statistically significant differences in scores of knowledge, attitude, and practice of IPH prevention in operating room nurses before and after training. The training program guided by adult learning theory could significantly increase the scores of IPH prevention-related knowledge of operating room nurses, improve the attitude of perioperative hypothermia prevention, and advance the compliance with IPH prevention interventions. Clinical Trial Registration number: 2023IIT109.
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Affiliation(s)
- Fengxia Chen
- Department of Operating Room, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Ailing Lian
- Department of Operating Room, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
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Huang J, Qi H, Lv K, Zhu Y, Wang Y, Jin L. Development and Psychometric Properties of a Scale Measuring Barriers to Perioperative Hypothermia Prevention for Anesthesiologists and Nurses. J Perianesth Nurs 2023; 38:703-709. [PMID: 37227366 DOI: 10.1016/j.jopan.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/27/2022] [Accepted: 11/06/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE To develop a scale that measures barriers to perioperative hypothermia prevention (BPHP) as perceived by anesthesiologists and nurses. DESIGN A methodological and prospective psychometric study. METHODS Based on the theoretical domains framework, the item pool was created through a literature review, qualitative interviews, and expert consultation. The scale was pretested with a sample of 154 key stakeholders in perioperative temperature management and then field tested with 416 anesthesiologists and nurses working at three hospitals in Southeast China. Item analysis, and reliability and validity analysis were performed. FINDINGS The average content validity index was 0.94. According to exploratory factor analysis, seven factors were obtained that could explain 70.283% of the total variance. Confirmatory factor analysis showed excellent or acceptable goodness-of-fit indices. The reliability analysis demonstrated that the scale had high internal consistency and temporal stability, with Cronbach's α, split-half coefficient and test-retest values of 0.926, 0.878 and 0.835, respectively. CONCLUSIONS The BPHP scale meets the psychometric criteria for reliability and validity and promises to be a useful quality measure for IPH management during the perioperative period. Further investigations on educational or resource needs and the development of an optimal perioperative hypothermia prevention protocol to narrow the gap between research evidence and clinical practice should be performed.
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Affiliation(s)
- Jingying Huang
- Postanesthesia Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiou Qi
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Kai Lv
- Postanesthesia Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiting Zhu
- Postanesthesia Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuting Wang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ling Jin
- Operating Room, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Güven B, İbrahimoğlu Ö, Kuş İ. Inadvertent Perioperative Hypothermia in Ambulatory Surgery Patients: Incidence, Risk Factors, and Prevention Initiatives. J Perianesth Nurs 2023; 38:792-798. [PMID: 37269277 DOI: 10.1016/j.jopan.2023.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Although the number and complexity of ambulatory surgical interventions has grown considerably over the years, it has not been fully established whether hypothermia still poses a risk for these interventions. In this study, we aimed to determine the incidence, risk factors, and methods applied to prevent perioperative hypothermia in ambulatory surgery patients. DESIGN A descriptive research design was used. METHODS The study was conducted with 175 patients between May 2021 and March 2022 in the outpatient units of a training and research hospital in Mersin, Turkey. Data were collected using the Patient Information and Follow-up Form. FINDINGS The incidence of perioperative hypothermia was 20% in ambulatory surgery patients. Hypothermia developed in 13.7% of the patients at the 0th minute at the PACU, and 96.6% of the patients were not warmed intraoperatively. We noted a statistically significant relationship between perioperative hypothermia and advanced age (≥60 years), high American Society of Anesthesiologists' (ASA) class, and low hematocrit values. In addition, we determined that the female gender, presence of chronic diseases, general anesthesia, and a long operation time were other risk factors for hypothermia in the perioperative period. CONCLUSIONS The incidence of hypothermia during ambulatory surgeries is lower than that in inpatient surgeries. The warming rate of ambulatory surgery patients, which is quite low, can be improved by increasing the awareness of the perioperative team and following the guidelines.
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Affiliation(s)
- Betül Güven
- Faculty of Health Sciences-Nursing, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Özlem İbrahimoğlu
- Faculty of Health Science-Nursing, Istanbul Medeniyet University, İstanbul, Turkey
| | - İlknur Kuş
- Mersin City Training and Research Hospital, Mersin, Turkey
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Munday J, Delaforce A, Heidke P, Rademakers S, Sturgess D, Williams J, Douglas C. Perioperative temperature monitoring for patient safety: A period prevalence study of five hospitals. Int J Nurs Stud 2023; 143:104508. [PMID: 37209531 DOI: 10.1016/j.ijnurstu.2023.104508] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Monitoring body temperature is essential for safe perioperative care. Without patient monitoring during each surgical phase, alterations in core body temperature will not be recognised, prevented, or treated. Safe use of warming interventions also depends on monitoring. Yet there has been limited evaluation of temperature monitoring practices as the primary endpoint. OBJECTIVE To investigate temperature monitoring practices during all stages of perioperative care. We examined what patient characteristics are associated with the rate of temperature monitoring, along with clinical variables such as warming intervention or exposure to hypothermia. DESIGN An observational period-prevalence study over seven days across five Australian hospitals. SETTINGS Four metropolitan, tertiary hospitals and one regional hospital. PARTICIPANTS We selected all adult patients (N = 1690) undergoing any surgical procedure and any mode of anaesthesia during the study period. METHODS Patient characteristics, perioperative temperature data, warming interventions and exposure to hypothermia were retrospectively collected from patient charts. We describe the frequencies and distribution of temperature data at each perioperative stage, including adherence to minimum temperature monitoring based on clinical guidelines. To examine associations with clinical variables, we also modelled the rate of temperature monitoring using each patient's count of recorded temperature measurements within their calculated time interval from anaesthetic induction to postanaesthetic care unit discharge. All analyses adjusted 95% confidence intervals (CI) for patient clustering by hospital. RESULTS There were low levels of temperature monitoring, with most temperature data clustered around admission to postanaesthetic care. Over half of patients (51.8%) had two or less temperatures recorded during perioperative care and one-third (32.7%) had no temperature data at all prior to admission to postanaesthetic care. Of all patients that received active warming intervention during surgery, over two-thirds (68.5%) had no temperature monitoring recorded. In our adjusted model, associations between clinical variables and the rate of temperature monitoring often did not reflect clinical risk or need: rates were decreased for those with greatest operative risk (American Society of Anesthesiologists Classification IV: rate ratio (RR) 0.78, 95% CI 0.68-0.89; emergency surgery: RR 0.89, 0.80-0.98), and neither warming interventions (intraoperative warming: RR 1.01, 0.93-1.10; postanaesthetic care unit warming: RR 1.02, 0.98-1.07) nor hypothermia at postanaesthetic care unit admission (RR 1.12, 0.98-1.28) were associated with monitoring rate. CONCLUSIONS Our findings point to the need for systems-level change to enable proactive temperature monitoring over all phases of perioperative care to enhance patient safety outcomes. REGISTRATION Not a clinical trial.
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Affiliation(s)
- Judy Munday
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Royal Brisbane and Women's Hospital, Herston, Queensland 4029, Australia; Faculty of Health and Nursing Science, University of Agder, Norway.
| | - Alana Delaforce
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Mater Health Services, South Brisbane, Queensland 4101, Australia; CSIRO Australian e-Health Research Centre, Brisbane, QLD 4029, Australia
| | - Penny Heidke
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Central Queensland University, Brisbane, Queensland 4000, Australia
| | - Sasha Rademakers
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Department of Health Western Australia, Perth 6000, Western Australia, Australia
| | - David Sturgess
- University of Queensland, St Lucia 4072, Queensland, Australia
| | | | - Clint Douglas
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Metro North Hospital and Health Service, Herston, Queensland 4029, Australia
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Munday J, Sturgess D, Oishi S, Bendeich J, Kearney A, Douglas C. Implementation of continuous temperature monitoring during perioperative care: a feasibility study. Patient Saf Surg 2022; 16:32. [PMID: 36153550 PMCID: PMC9509652 DOI: 10.1186/s13037-022-00341-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Continuous body temperature monitoring during perioperative care is enabled by using a non-invasive “zero-heat-flux” (ZHF) device. However, rigorous evaluation of whether continuous monitoring capability improves process of care and patient outcomes is lacking. This study assessed the feasibility of a large-scale trial on the impact of continuous ZHF monitoring on perioperative temperature management practices and hypothermia prevention. Methods A feasibility study was conducted at a tertiary hospital. Participants included patients undergoing elective surgery under neuraxial or general anesthesia, and perioperative nurses and anesthetists caring for patient participants. Eighty-two patients pre and post introduction of the ZHF device were enrolled. Feasibility outcomes included recruitment and retention, protocol adherence, missing data or device failure, and staff evaluation of intervention feasibility and acceptability. Process of care outcomes included temperature monitoring practices, warming interventions and perioperative hypothermia. Results There were no adverse events related to the device and feasibility of recruitment was high (60%). Treatment adherence varied across the perioperative pathway (43 to 93%) and missing data due to electronic transfer issues were identified. Provision of ZHF monitoring had most impact on monitoring practices in the Post Anesthetic Care Unit; the impact on intraoperative monitoring practices was minimal. Conclusions Enhancements to the design of the ZHF device, particularly for improved data retention and transfer, would be beneficial prior to a large-scale evaluation of whether continuous temperature monitoring will improve patient outcomes. Implementation research designs are needed for future work to improve the complex area of temperature monitoring during surgery. Trial registration Prospective registration prior to patient enrolment was obtained from the Australian and New Zealand Clinical Trials Registry (ANZCTR) on 16th April 2021 (Registration number: ACTRN12621000438853).
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15
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Deng X, Yan J, Wang S, Li Y, Shi Y. Clinical Survey of Current Perioperative Body Temperature Management: What Major Factors Influence Effective Hypothermia Prevention Practice? J Multidiscip Healthc 2022; 15:1689-1696. [PMID: 35965636 PMCID: PMC9374200 DOI: 10.2147/jmdh.s376423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Inadvertent intraoperative hypothermia (IIH) is generally associated with several postoperative complications. Inspite of the existing guidelines, the global incidence of IIH remains unacceptably high. Understanding the conditions that influence temperature management is critical for developing future interventions to improve the postoperative patient outcomes. This study aimed to identify the major factors that hinder the implementation of IIH prevention practices. Methods Through a literature research, pilot small-sample investigation, and expert suggestions, 11 factors that may hinder the implementation of IIH prevention practices were identified. A questionnaire was developed, and each question was used to assess each factor. After approval by the Research Ethics Board, the questionnaires were sent to the staff anaesthesiologists at two academic hospitals via WeChat. Each answer was coded according to the degree to which the factor was affected, as anticipated. Finally, the answers were analysed based on the 80/20 rule to identify the major barriers to effective temperature management. Results We included 195 participants. Knowledge, memory, attention and decision processes, beliefs about consequences, and environmental context and resources were the major factors, with cumulative composition ratios of 24%, 43.4%, 57.7%, and 70.7%, respectively. Meanwhile, behavioural regulation and social influence were the secondary factors, with cumulative composition ratios of 80.4% and 87.5%, respectively. Reinforcement, confidence in capacity, duty realisation, skills, and intention were the general factors with cumulative composition ratios of 94.3%, 99.8%, 100%, 100%, and 100%, respectively. Conclusion Four factors-knowledge, memory, attention and decision process, beliefs about consequences, and environmental context and resources-were the major factors that influence the effective hypothermia prevention practice. Relevance to Clinical Practice These major factors will be used in further studies as a basis to develop the corresponding solutions and improve the patient outcomes in clinical practice.
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Affiliation(s)
- Xiaoqian Deng
- Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, People's Republic of China
| | - Junyu Yan
- Department of Anesthesiology, Karamay Hospital of Integrated Traditional Chinese and Western Medicine, Karamay, People's Republic of China
| | - Shaungwen Wang
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Yifan Li
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Yun Shi
- Department of Anesthesiology, Children's Hospital of Fudan University, Fudan University, Shanghai, People's Republic of China
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16
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Perioperative temperature monitoring practices in Australia: A multidisciplinary cross-sectional survey. Collegian 2022. [DOI: 10.1016/j.colegn.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Dai Z, Zhang Y, Yi J, Huang Y. Validation of a Prediction Model for Intraoperative Hypothermia in Patients Receiving General Anesthesia. Int J Clin Pract 2022; 2022:6806225. [PMID: 36187909 PMCID: PMC9509213 DOI: 10.1155/2022/6806225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES There have been no fully validated tools for the rapid identification of surgical patients at risk of intraoperative hypothermia. The objective of this study was to validate the performance of a previously established prediction model in estimating the risk of intraoperative hypothermia in a prospective cohort. METHODS In this observational study, consecutive adults scheduled for elective surgery under general anesthesia were enrolled prospectively at a tertiary hospital between September 4, 2020, and December 28, 2020. An intraoperative hypothermia risk score was calculated by a mobile application of the prediction model. A wireless axillary thermometer was used to continuously measure perioperative core temperature as the reference standard. The discrimination and calibration of the model were assessed, using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow goodness-of-fit test, and Brier score. RESULTS Among 227 participants, 99 (43.6%) developed intraoperative hypothermia, and 10 (4.6%) received intraoperative active warming with forced-air warming. The model had an AUC of 0.700 (95% confidence interval [CI], 0.632-0.768) in the overall cohort with adequate calibration (Hosmer-Lemeshow χ 2 = 13.8, P=0.087; Brier score = 0.33 [95% CI, 0.29-0.37]). We categorized the risk scores into low-risk, moderate-risk, and high-risk groups, in which the incidence of intraoperative hypothermia was 23.0% (95% CI, 12.4-33.5), 43.4% (95% CI, 33.7-53.2), and 62.7% (95% CI, 51.5-74.3), respectively (P for trend <0.001). CONCLUSIONS The intraoperative hypothermia prediction model demonstrated possibly helpful discrimination and adequate calibration in our prospective validation. These findings suggest that the risk screening model could facilitate future perioperative temperature management.
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Affiliation(s)
- Ziyi Dai
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jie Yi
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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18
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Wilson RD, Nelson G. Maternal and fetal hypothermia: more preventive compliance is required for a mother and her fetus while undergoing cesarean delivery; a quality improvement review. J Matern Fetal Neonatal Med 2021; 35:8652-8665. [PMID: 34689687 DOI: 10.1080/14767058.2021.1993816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Cesarean delivery is common, involves two patients, has numerous multi-disciplinary health care providers involved in the delivery management, but has variable levels of anesthesia and health services implementation for decreasing maternal hypothermia and the maternal and neonatal morbidity (and mortality). Limited implementation for either of the ERAS-CD or the ERAC guidelines, for inadvertent or preventive maternal hypothermia, is likely to be occurring on labor delivery floors. This Quality Improvement (QI) review focuses on cesarean delivery and maternal hypothermia. METHODS This quality and safety initiative used SQUIRE 2.0 methodology and concurrent PubMed searches to identify systematic review, meta-analysis, topic directed studies, additional published cohorts in the topic area not included in SR/MA, limited case reports that had specific clinical outcomes related to maternal hypothermia and fetal effects. RESULTS Two quality and safety improvement guidelines have defined the hypothermia activity element differently, with ERAS-CD recommending to prevent hypothermia, while ERAC recommending to maintain normothermia. The peer-reviewed literature indicates that the knowledge associated with surgical hypothermia outcome is known but it is not implemented for maternal cesarean delivery care. Increased maternal-effect recognition, surveillance, triage, and evidenced-based protocol management is required for the maternal - neonatal dyad undergoing cesarean delivery for the clinical reduction/prevention of neonatal hypothermia that has proven evidence-based maternal morbidity and neonatal morbidity/mortality. CONCLUSION TEAM-based anesthesia, obstetrical, neonatology-pediatrics and nursing research collaboration is required through quality-safety-ERAS-ERAC directed processes. Healthcare system recognition and financial support is required for maternal-fetal-neonatal hypothermia prevention protocols implementation.
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Affiliation(s)
- R Douglas Wilson
- Department of Obstetrics and Gynecology, Cumming School of Medicine University of Calgary, Calgary, Canada
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, Cumming School of Medicine University of Calgary, Calgary, Canada
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19
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Martins LA, Camargo CLD, Fernandes ETBS, Marques PF, Aguiar ACDSA, Castro CTD. Prevention of hypothermia in newborn submitted to surgical procedures: an integrative review. Rev Bras Enferm 2021; 75:e20200940. [PMID: 34495128 DOI: 10.1590/0034-7167-2020-0940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/27/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to discuss in the scientific literature the strategies used to prevent hypothermia in newborns undergoing surgical procedures. METHODS this is an integrative literature review, with structured search in April and May 2020 in 08 databases, using the descriptors: Hypothermia; Surgical Procedures, Operative; Infant, Newborn; Protocols. Four primary studies were selected and analyzed using three instruments to assess the methodological quality of the Joanna Briggs Institute and content analysis. RESULTS Among the strategies used, the following stand out: room temperature control; establishment of humidification and quality of air conditioning cleanliness; use of a heated incubator or cradle; use of thermal mattress; use of caps and blanket; heated fluids; temperature monitoring and abdominal organ coverage. CONCLUSION good hypothermia prevention strategies were identified, despite the small number of publications on this topic; thus, it points out the need for research with strong evidence.
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Affiliation(s)
- Lucas Amaral Martins
- Universidade Federal da Bahia. Salvador, Bahia, Brazil.,Universidade Federal do Recôncavo da Bahia. Santo Antônio de Jesus, Bahia, Brazil
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20
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Munday J, Higgins N, Jones L, Vagenas D, Van Zundert A, Keogh S. Zero-Heat-Flux and Esophageal Temperature Monitoring in Orthopedic Surgery: An Observational Study. J Multidiscip Healthc 2021; 14:1819-1827. [PMID: 34285500 PMCID: PMC8286425 DOI: 10.2147/jmdh.s313310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Perioperative hypothermia prevention requires regular, accurate, and consistent temperature monitoring. Zero-heat-flux (ZHF) thermometry offers a non-invasive, measurement method that can be applied across all surgical phases. The purpose of this study was to measure agreement between the zero-heat-flux device and esophageal monitoring, sensitivity, and specificity to detect hypothermia and patient acceptability amongst patients undergoing upper and lower limb orthopedic surgery. Patients and Methods This prospective, observational study utilized Bland–Altman analysis and Lin’s concordance coefficient to measure agreement between devices, sensitivity and specificity to detect hypothermia and assessed patient acceptability amongst 30 patients between December 2018 and June 2019. Results Bias was observed between devices via Bland Altman, with bias dependent on actual temperature. The mean difference ranged from −0.16°C at 34.9°C (where the mean of ZHF was lower than the esophageal device) to 0.46°C at 37.25°C (where the mean of ZHF was higher than esophageal device), with 95% limits of agreement (max) upper LOA = 0.80 to 1.41, lower LOA = −1.12 to −0.50. Seventy-five percentage of zero-heat-flux measurements were within 0.5°C of esophageal readings. Patient acceptability was high; 96% (n=27) stated that the device was comfortable. Conclusion ZHF device achieved lesser measurement accuracy with core (esophageal) temperature compared to earlier findings. Nonetheless, due to continuous capability, non-invasiveness and patient reported acceptability, the device warrants further evaluation. Title Registration The study was registered at www.ANZCTR.org.au (reference: ACTRN12619000842167).
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Affiliation(s)
- Judy Munday
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Niall Higgins
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Lee Jones
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Research Methods Group, Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - André Van Zundert
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia & Queensland University of Technology, Brisbane, QLD, Australia
| | - Samantha Keogh
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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21
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Etherington C, Burns JK, Kitto S, Brehaut JC, Britton M, Singh S, Boet S. Barriers and enablers to effective interprofessional teamwork in the operating room: A qualitative study using the Theoretical Domains Framework. PLoS One 2021; 16:e0249576. [PMID: 33886580 PMCID: PMC8061974 DOI: 10.1371/journal.pone.0249576] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Effective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected gains for patient safety or surgical culture. In order to optimize OR teamwork in a targeted and evidence-based manner, it is first necessary to conduct a comprehensive, theory-informed assessment of barriers and enablers from an interprofessional perspective. Methods This qualitative study was informed by the Theoretical Domains Framework (TDF). Volunteer, purposive and snowball sampling were conducted primarily across four sites in Ontario, Canada and continued until saturation was reached. Interviews were recorded, transcribed, and de-identified. Directed content analysis was conducted in duplicate using the TDF as the initial coding framework. Codes were then refined whereby similar codes were grouped into larger categories of meaning within each TDF domain, resulting in a list of domain-specific barriers and enablers. Results A total of 66 OR healthcare professionals participated in the study (19 Registered Nurses, two Registered Practical Nurses, 17 anaesthesiologists, 26 surgeons, two perfusionists). The most frequently identified teamwork enablers included people management, shared definition of teamwork, communication strategies, positive emotions, familiarity with team members, and alignment of teamwork with professional role. The most frequently identified teamwork barriers included others’ personalities, gender, hierarchies, resource issues, lack of knowledge of best practices for teamwork, negative emotions, conflicting norms and perceptions across professions, being unfamiliar with team members, and on-call/night shifts. Conclusions We identified key factors influencing OR teamwork from an interprofessional perspective using a theoretically informed and systematic approach. Our findings reveal important targets for future interventions and may ultimately increase their effectiveness. Specifically, achieving optimal teamwork in the OR may require a multi-level intervention that addresses individual, team and systems-level factors with particular attention to complex social and professional hierarchies.
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Affiliation(s)
- Cole Etherington
- Department of Anaesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Joseph K. Burns
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie C. Brehaut
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Meghan Britton
- Main Operating Room, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sukhbir Singh
- Department of Obstetrics & Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvain Boet
- Department of Anaesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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22
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Issac H, Taylor M, Moloney C, Lea J. Exploring Factors Contributing to Chronic Obstructive Pulmonary Disease (COPD) Guideline Non-Adherence and Potential Solutions in the Emergency Department: Interdisciplinary Staff Perspective. J Multidiscip Healthc 2021; 14:767-785. [PMID: 33854328 PMCID: PMC8039430 DOI: 10.2147/jmdh.s276702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/04/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose Acute exacerbations of chronic obstructive pulmonary disease (COPD) have a significant and prolonged impact on health-related quality of life, patient outcomes, and escalation of pulmonary function decline. COPD-X guidelines published in 2003 subsist to facilitate a shift from the emphasis on pharmacological treatment to a more holistic multi-disciplinary interventions approach. Despite the existing comprehensive recommendations, readmission rates have increased in the last decade. Evidence to date has reported sub-optimal COPD guidelines adherence in emergency departments. This qualitative study explored contributing factors to interdisciplinary staff non-adherence and utilisation of COPD-X guidelines in a major Southern Queensland Emergency Department. Methods Semi-structured qualitative interviews with interdisciplinary staff were conducted in an emergency department. A purposive sample of doctors, nurses, physiotherapists, pharmacist and a social worker were recruited. Interviews were digitally recorded, de-identified and transcribed verbatim. Data analysis followed a coding process against the Theoretical Domains Framework (TDF) to examine implementation barriers and potential solutions. Identified factors affecting non-adherence and underutilisation of guidelines were then mapped to the capability, opportunity, motivation, behaviour model (COM-B) and behaviour change wheel (BCW) to inform future implementation recommendations. Results Prominent barriers influencing the clinical uptake of COPD guidelines were identified using TDF analysis and included knowledge, professional role clarity, clinical behaviour regulation, memory, attention, and decision process, beliefs about departmental capabilities, environmental context and resources. Potential interventions included education, training, staffing, funding and time-efficient digitalised referrals and systems management reminders to prevent COPD readmissions, remissions and improve patient health-related quality of life. Conclusion Implementation strategies such as electronic interdisciplinary COPD proforma that facilitates a multimodal approach with appropriate patient/staff resources and referrals prior to discharge from an ED require further exploration. Greater clarity around which components of the COPD X guidelines must be applied in ED settings needs to stem from future research.
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Affiliation(s)
- Hancy Issac
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
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