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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, 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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Gustafsson IL, Elmqvist C, Fridlund B, Schildmeijer K, Rask M. Nurse anesthetists' perceptions of heat conservation measures in connection with surgery - a phenomenographic study. BMC Nurs 2023; 22:321. [PMID: 37723475 PMCID: PMC10506279 DOI: 10.1186/s12912-023-01508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND To minimize the risk of perioperative hypothermia, it is recommended that healthcare professionals be familiar with heat conservation measures and use passive and active warming methods, in line with international guidelines. However, there is a low level of adherence perioperatively to the use of heat conservation measures. To understand why, there is a need to capture the nurse anesthetists' perspective. The aim is to describe nurse anesthetists' perceptions of heat conservation measures in connection with surgery. METHODS An inductive descriptive design with a phenomenographic approach was chosen. A total of 19 nurse anesthetists participated and were interviewed. Data were analyzed according to Larsson and Holmström's phenomenographic seven-step model. RESULTS Six ways of understanding the phenomenon heat conservation measures in connection with surgery were found: the preventive, the useable, the untenable, the caring, the adaptive, and the routine care approach. These approaches were related to each other in a flexible way, allowing for several to co-exist at the same time, depending on the situation. CONCLUSIONS Nurse anesthetists want to prevent the patients' heat loss and maintain normothermia, regardless of the type of surgery. This willingness, motivation, and intention enable the use of heat conservation measures. However, there are perceptions that have an impact, such as doubts and uncertainty, access, time and financial constraints, preconditions, routines or habits, and lack of availability of education/training. These barriers will require support from an organizational level to promote lifelong education and guidelines. As well as offer education at the nurse anesthetists' program.
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Affiliation(s)
- Ingrid L Gustafsson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, S-351 95, Sweden.
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, S-351 95, Sweden.
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, S-501 90, Sweden.
| | - Carina Elmqvist
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, S-351 95, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, S-351 95, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, 352 57, Sweden
| | - Bengt Fridlund
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, S-351 95, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, S-351 95, Sweden
| | - Kristina Schildmeijer
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, S-351 95, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, S-391 82, Sweden
| | - Mikael Rask
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, S-351 95, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, S-351 95, Sweden
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Zucconi G, Marchello AM, Demarco C, Fortina E, Milano L. Health Technology Assessment for the Prevention of Peri-Operative Hypothermia: Evaluation of the Correct Use of Forced-Air Warming Systems in an Italian Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:133. [PMID: 36612455 PMCID: PMC9819292 DOI: 10.3390/ijerph20010133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
This study investigates the implications of using a system for the maintenance of normothermia in the treatment of patients undergoing surgery, determining whether the FAW (Forced-Air Warming) systems are more effective and efficient than the non-application of appropriate protocols (No Technology). We conducted Health Technology Assessment (HTA) analysis, using both real-world data and the data derived from literature, assuming the point of view of a medium-large hospital. The literature demonstrated that Inadvertent Perioperative Hypothermia (IPH) determines adverse events, such as surgical site infection (FAW: 3% vs. No Technology: 12%), cardiac events (FAW: 3.5% vs. No Technology: 7.6%) or the need for blood transfusions (FAW: 6.2% vs. No Technology: 7.4%). The correct use of FAW allows a medium saving of 16% per patient to be achieved, compared to the non-use of devices. The Cost Effectiveness Value (CEV) is lower in the hypothesis of FAW: it enables a higher efficacy level with a contextual optimization of patients' path costs. The social cost is reduced by around 30% and the overall hospital days are reduced by between 15% and 26%. The qualitative analyses confirmed the results. In conclusion, the evidence-based information underlines the advantages of the proper use of FAW systems in the prevention of accidental peri-operative hypothermia for patients undergoing surgery.
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Affiliation(s)
| | | | | | | | - Ljdia Milano
- Hospital Consulting Spa, 50012 Bagno a Ripoli, Italy
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Li L, Lu Y, Yang LL, Xu W, Yu JK. Construction and validation of postoperative hypothermia prediction model for patients undergoing joint replacement surgery. J Clin Nurs 2022. [PMID: 35995762 DOI: 10.1111/jocn.16503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/19/2022] [Accepted: 08/06/2022] [Indexed: 11/29/2022]
Abstract
AIM To construct and validate a postoperative hypothermia prediction model for patients undergoing joint replacement surgery. BACKGROUND Postoperative hypothermia is one of the harmful perioperative complications in patients undergoing joint replacement surgery. The previous studies mainly focused on intraoperative hypothermia prediction models. The prediction model for postoperative hypothermia in patients with joint replacement surgery was understudied. DESIGN Cohort study. METHODS We collected data from 503 participants undergoing joint replacement surgery in a tertiary hospital from January 2019 to December 2021. Of those, 404 cases were assigned to the modelling and 99 to the validation groups. Logistic regression was used to construct the model. The AUC was used to test the predictive effect of the model. Finally, 99 cases were used to verify the application effect of the model. A TRIPOD checklist was used to guide the reporting of this study. RESULTS The factors entered into the prediction model were age, intraoperative hypothermia, BMI, heat preservation measures and platelet (PLT). The model was constructed as follows: Logit (P) = .537 + 3.669 × 1 (intraoperative hypothermia) + .030 × age - .289 × BMI + 2.857 × 1 (intraoperative insulation measures) + .003 × PLT. Hosmer-Lemeshow test, p = .608, the area under the receiver operating characteristic curve (AUC) was .861. The Youden index was .530, the sensitivity was .599 and the specificity was .93. The incidence of postoperative hypothermia in the modelling group was 42.93% (173/404), and that in the verification group was 43.43% (43/99), χ2 = .012, p = .912. The correct practical application rate was 87.88%. This model has a good application effect. CONCLUSION The current prediction model provided a reference for clinical screening of patients with high-risk hypothermia after joint replacement surgery. RELEVANCE TO CLINICAL PRACTICE Clinical nurses can use the developed prediction model to predict the occurrence of postoperative hypothermia and provide a reference for the preventive measure.
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Affiliation(s)
- Leilei Li
- Operating Room, The Fourth Affiliated Hospital of School of Medicine, Zhejiang University, Yiwu, ZhejiangProvince, China
| | - Yubing Lu
- Operating Room, The Fourth Affiliated Hospital of School of Medicine, Zhejiang University, Yiwu, ZhejiangProvince, China
| | - Li Li Yang
- Nursing Department, the Fourth Affiliated Hospital of School of Medicine, Zhejiang University, Yiwu, Zhejiang, China
| | - Wei Xu
- Operating Room, The Fourth Affiliated Hospital of School of Medicine, Zhejiang University, Yiwu, ZhejiangProvince, China
| | - Jing Kai Yu
- Operating Room, The Fourth Affiliated Hospital of School of Medicine, Zhejiang University, Yiwu, ZhejiangProvince, China
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Urfalioglu A, Urfalioglu S, Oksuz G, Doganer A, Teksen S, Guler O, Calisir F. The effects of active warming on perioperative inadvertent hypothermia in patients undergoing vitreoretinal surgery under local anesthesia. Indian J Ophthalmol 2021; 69:308-313. [PMID: 33463580 PMCID: PMC7933865 DOI: 10.4103/ijo.ijo_227_20] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose: Perioperative inadvertent hypothermia (PIH) is the decrease in core temperature below 36°C. We aimed to assess whether PIH develops in patients operated under local anesthesia (ULA) for vitreoretinal surgery in the operating room and investigate active warming efficacy. Methods: Seventy-two patients were divided into two groups: Group 1 contained unwarmed patients (n = 36), and Group 2, warmed patients (n = 36). The core temperatures, heart rate (HR), and mean arterial pressure (MAP) of the patients were measured at the beginning of surgery, after 20 min, 40 min, 1 h, at the end of the operation, and during the postoperative period. Results: PIH incidence was 44.6% in Group 1, whereas no hypothermia was observed in Group 2. Patient temperatures at 20 min (P = 0.001), 40 min (P < 0.001), 1 h (P < 0.001), the end of the operation (P < 0.001), and the postoperative period (P < 0.001) were significantly higher in Group 2 than in Group 1. Patient HRs at the end of the operation and during the postoperative period were significantly lower in Group 2 (P = 0.005) than in Group 1 (P < 0.001). The intraoperative 40th (P = 0.044) and 60th (P < 0.001) minutes, end of operation (P < 0.001), and postoperative MAP (P < 0.001) values of Group 1 were significantly higher than those of Group 2. Conclusion: PIH may develop in patients operated ULA, especially with a low ambient temperature. Actively warming may help prevent the harmful effects of PIH.
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Affiliation(s)
- Aykut Urfalioglu
- Department of Anesthesiology and Reanimation, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | - Selma Urfalioglu
- Department of Ophthalmology, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | - Gozen Oksuz
- Department of Anesthesiology and Reanimation, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | - Adem Doganer
- Department of Biostatistics and Medical Informatics, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | - Seyma Teksen
- Department of Anesthesiology and Reanimation, Afşin State Hospital, Kahramanmaras, Turkey
| | - Ozlem Guler
- Department of Emergency Medicine, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | - Feyza Calisir
- Department of Anesthesiology and Reanimation, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
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Xiao Y, Zhang R, Lv N, Hou C, Ren C, Xu H. Effects of a preoperative forced-air warming system for patients undergoing video-assisted thoracic surgery: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e23424. [PMID: 33235123 PMCID: PMC7710179 DOI: 10.1097/md.0000000000023424] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The incidence of intraoperative hypothermia is still high despite the proposal of different preventive measures during thoracoscopic surgery. This randomized control study evaluated the effects of 30-minute prewarming combined with a forced-air warming system during surgery to prevent intraoperative hypothermia in patients undergoing video-assisted thoracic surgery under general anesthesia combined with erector spinae nerve block. METHODS Ninety-eight patients were randomly and equally allocated to prewarming or warming groups (n = 49 each). The primary outcome was the incidence of intraoperative hypothermia. Secondary outcomes were core temperature, irrigation and infused fluid, estimated blood loss, urine output, type of surgery, intraoperative anesthetic dosage, hemodynamics, recovery time, the incidence of postoperative shivering, thermal comfort, postoperative sufentanil consumption and pain intensity, patient satisfaction, and adverse events. RESULTS The incidence of intraoperative hypothermia was significantly lower in the prewarming group than the warming group (12.24% vs 32.65%, P = .015). Core temperature showed the highest decrease 30 minutes after surgery start in both groups; however, the rate was lower in the prewarming than in the warming group (0.31 ± 0.04°C vs 0.42 ± 0.06°C, P < .05). Compared with the warming group, higher core temperatures were recorded for patients in the prewarming group from T1 to T6 (P < .05). Significantly fewer patients with mild hypothermia were in the prewarming group (5 vs 13, P = .037) and recovery time was significantly reduced in the prewarming group (P < .05). Although the incidence of postoperative shivering was lower in the prewarming group, it was not statistically significant (6.12% vs 18.37%, P = .064). Likewise, the shivering severity was similar for both groups. Thermal comfort was significantly increased in the prewarming group, although patient satisfaction was comparable between the 2 groups (P > .05). No adverse events occurred associated with the forced-air warming system. Both groups shared similar baseline demographics, type of surgery, total irrigation fluid, total infused fluid, estimated blood loss, urine output, intraoperative anesthetic dosage, hemodynamics, duration of anesthesia and operation time, postoperative sufentanil consumption, and pain intensity. CONCLUSION In patients undergoing video-assisted thoracic surgery, prewarming for 30 minutes before the induction of anesthesia combined with a forced-air warming system may improve perioperative core temperature and the thermal comfort, although the incidence of postoperative shivering and severity did not improve.
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Affiliation(s)
| | | | - Na Lv
- Department of Operation Room
| | | | - Chunguang Ren
- Department of Anaesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Huiying Xu
- Department of Anaesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
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