1. Feel the Warmth: Keeping Patients Warm During Surgery Surgical Services Physicians & Staff SAC, OR, Anesthesia & PACU Endorsed by OR/PAR Committee

2. SCIP: Surgical Care Improvement Project Surgical site infections (SSI) are a major complication after surgery, resulting in considerable morbidity, mortality, and resource utilization. The costs of SSI vary depending on the type of surgery and infecting pathogen; estimates range from $3,000-$29,000. 1 Proper use of antibiotics – giving the right drug at the right time – is effective in preventing infections after surgery. 2 Other perioperative measures - glucose control, appropriate hair removal, and maintaining temperature control - have also been proven effective in reducing infections. 1 Deverick, JA, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals, Infection Control & Hospital Epidemiology October 2008 Supplement; 29:S51-61 2 Bratzler, DW, et al. Use of Antimicrobial Prophylaxis for Major Surgery: Baseline Results from the National Surgical Infection Prevention Project, Arch Surg Feb 2005; 140:174-182. Confidential: Quality Improvement Material

3. Loyola’s success with SCIP measures MeasureCompliance Antibiotics given within 60 minutes of surgical incision 96% Appropriate antibiotic97% Antibiotics stopped within 24 hours after surgery 96% Controlled post operative serum glucose 94% Appropriate hair removal99% Post operative temperature control75% 2008/2009 activities were focused to improve post operative temperature control Confidential: Quality Improvement Material

4. Keeping Surgical Patients Warm Why is it important?  Prevention of hypothermia reduces hospital length of stay, surgical site infections, blood loss, post-op shivering, redistribution hypothermia, the need for blood transfusions and altered medication metabolism.  Historically this publicly reported measure has only applied to colon surgeries. In 2009, it will be expanded to include all surgeries greater than 60 minutes. Baseline performance:  Colon surgeries – 75% compliance  All surgeries – 71% compliance Goal:  All patients undergoing surgery will achieve normal body temperature (normothermia) immediately after surgery. Normothermia is defined as a temperature of 96.8°F – 100.4°F. Confidential: Quality Improvement Material

5. Tests of change to improve normothermia Cycle One What we did:  Initiated passive and active warming techniques preoperatively in the Surgical Admitting Center and Pre-op Holding:  Passive warming: thermal hats, slippers, thermal blankets  Active warming: Forced warm air device (bair hugger) as indicated, and warmed fluids for infusions What we learned:  Noted improved compliance with post op normothermia  Patient temperatures in the OR were low  Inconsistent MD/Staff compliance with warming measures  OR/PAR Committee agreed to continue the pilot Confidential: Quality Improvement Material

6. Tests of change to improve normothermia Cycle Two: What we did:  Passive warming: thermal hats, slippers, thermal blankets  Active warming: Forced warm air device (bair hugger) as indicated, and warmed fluids for infusions  NEW: Increased the Operating Room temperature to 72 degrees at beginning of case What we learned:  Noted decreased compliance with post op normothermia  Patients complained of being too hot; they took their warming devices off Confidential: Quality Improvement Material

7. Tests of change to improve normothermia Cycle Three: What we did:  Passive warming: thermal hats, slippers, thermal blankets  Active warming: Forced warm air device (bair hugger) as indicated, and warmed fluids for infusions  Set up automatic changes to increase the Operating Room temperature to 72 degrees at beginning of case  NEW: Patient education/Staff education What we learned:  Noted improved compliance with normothermia  Improved patient compliance with warming devices Confidential: Quality Improvement Material

8. Improved compliance with normothermia Confidential: Quality Improvement Material

9. Results and Analysis Improved compliance with normothermia:  100% compliance for colon surgery patients  95% compliance for all surgical patients in the final cycle Project success factors:  Use of perioperative passive and active warming measures  Surgical Admitting Center  Pre-op Holding  Operative Rooms  Post Anesthesia Recovery  Maintenance of appropriate Operating Room temperatures  Physician/Staff education  Patient education Confidential: Quality Improvement Material

10. Next Steps  Incorporate a standard reminder at the end of each procedure  “Re-warm the patient”  Continue awareness education  Physicians and staff  Patients and families  Monitor ongoing performance:  Analyze outliers and collaborate to improve Confidential: Quality Improvement Material Magnet Forces: 6 - Quality of Care; 7 - Quality Improvement; 13 - Interdisciplinary Relationships