Tag Archives: Patient Satisfaction

Jun 23, 2017

8 Reasons the 3M™ Bair Hugger™ System is the Gold Standard in Patient Warming

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The 3M Bair Hugger System is the gold standard for patient warming. See the research in our updated Compendium.

The 3M Bair Hugger System is the gold standard for patient warming. See the research in our updated Compendium.

The 3M™ Bair Hugger™ forced-air warming system keeps patients warm throughout the perioperative process, which is integral to optimal clinical care and patient comfort. Below are eight great reasons you can trust the Bair Hugger system for your patient warming needs.

  1. Over 80% of US hospitals rely on the 3M Bair Hugger system to maintain normothermia.
  2. The 3M Bair Hugger system has safely and effectively warmed patients during surgery for nearly 30 years.
  3. More than 200 million patients have been warmed by Bair Hugger warming blankets or warming gowns.
  4. The number of patients warmed using the Bair Hugger system increases by nearly 50,000 each and every day.
  5. 8 of the top 10 orthopedic hospitals in the U.S. trust the 3M Bair Hugger system for their patient warming needs.¹
  6. The clinical effectiveness of forced-air warming has been documented in over 170 clinical studies and more than 60 randomized controlled clinical trials. Download the Bair Hugger research compendium to learn more.
  7. The 3M Bair Hugger system’s portfolio of 25 blanket designs (including seven underbody models) and three gown styles provides a warming option for nearly any surgical procedure.
  8. The 3M Bair Hugger Model 775 temperature management unit’s performance, precision and ease-of-use stands out from the competition.

Learn more about the 3M Bair Hugger system, or download the Bair Hugger Research Compendium.

1. U.S. News & World Report (online edition); 2015-16 Top Hospitals edition, Best Hospitals for Adult Orthopedics. http://health.usnews.com/best-hospitals/rankings/orthopedics. Published July 21, 2015.
May 19, 2016

The Prevention of Perioperative Hypothermia Toolkit

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The Prevention of Perioperative Hypothermia

Guest blogger: Victoria M. Steelman, PhD, RN, CNOR, FAAN Associate Professor, College of Nursing, The University of Iowa Disclosure: Victoria M. Steelman, PhD, RN, CNOR, FAAN has served as a consultant for 3M and VitaHEAT. This article is sponsored by 3M.

The Prevention of Perioperative Hypothermia Toolkit

I am sometimes asked, “Is perioperative hypothermia really a big deal?” The answer is “yes, it is.” Most patients undergoing surgery will become hypothermia unless we use effective interventions to prevent it.

Why is preventing perioperative hypothermia important?

It is important to prevent perioperative hypothermia because it is associated with negative patient outcomes. Perioperative hypothermia increases:

  • surgical site infection risk,1
  • morbid cardiac events,2
  • blood loss,3,4
  • length of stay in the recovery room,5 and
  • impairment of drug metabolism.5

All of this increases the cost of healthcare.

Why does hypothermia occur?

One common misconception is that perioperative hypothermia is caused by the operating room being cool, and if the room temperature is increased, hypothermia will not occur. This is a myth. Although the room temperature plays a role, anesthesia plays the primary role. General and regional anesthesia impair the normal thermoregulatory responses.6 Upon induction of anesthesia, heat is redistributed from the core to the peripheral tissues, which are much (2-4oC) cooler. This causes the core temperature to drop significantly during the first hour of anesthesia.7 Anesthesia also impairs the body’s ability to respond to cold. Normally, the body would respond to a drop in temperature of 0.4oC. An anesthetized patient does not respond until there is a 4oC drop in core temperature.So, the patient does not produce enough heat to overcome the initial hypothermia.

Will using cotton blankets prevent hypothermia?

Passive warming with blankets retains heat. But, because the anesthetized patient is unable to produce enough heat, retention of heat alone is inadequate. Applying heated cotton blankets is only slightly more effective, and the benefit only lasts 10 minutes.9 In a randomized clinical trial, applying heated cotton blankets failed to prevent hypothermia.10

Will heating insufflation gases for laparoscopy prevent hypothermia?

Another commonly used, ineffective way of preventing hypothermia is heating the carbon dioxide used for insufflation during laparoscopy. A meta-analysis of 16 randomized clinical trials found that heating CO2 gas had no effect on core temperature, and there was no evidence to support the use of heated CO2 gas, with our without humidification, for laparoscopic surgery.11

How can we prevent hypothermia?

Applying heat to actively warm the patient is required to prevent perioperative hypothermia. The most common method of active warming is forced air warming (FAW), which distributes warm air over the skin surface, heating peripheral tissues, and minimizing core-to-periphery temperature gradient. Intraoperative FAW is more effective in maintaining body temperature than cotton blankets,10,12  reflective blankets,12 or thermo-lite® insulation.12,13

What patients should receive active warming?

Patients undergoing surgery that will be at least 30 minutes long, with general or regional anesthesia (spinal, epidural) should be actively warmed.

When should we use active warming?

To be most effective, active warming should be initiated preoperatively for at least 30 minutes and also used intraoperatively. Actively warming the patient preoperatively minimizes heat lost during redistribution of heat from the core to periphery upon induction of anesthesia, and minimizes the incidence of hypothermia.14-16

Why are hospitals not using these evidence-based practices?

Unfortunately, active warming is not always used when needed and is often not used correctly. First, practitioners are not knowledgeable enough about perioperative hypothermia, and do not always consider it a priority. Secondly, they do not understand the importance of prewarming the patient, and often start active warming after induction of anesthesia. Third, there was a quality performance measure that has been retired that required active warming or normothermia. Practitioners were in compliance with the measure even if they used active warming incorrectly, starting it after induction of anesthesia, and the patient became hypothermic.17 Actual evaluation of patient outcomes and reducing the incidence of hypothermia were not emphasized, resulting in a “checklist mentality”. And, lastly, complacency is an incredibly strong force, and a concentrated effort is required to make a change in practice.

How can we get practitioners to use this evidence to prevent perioperative hypothermia?

We need to use a combination of strategies to engage busy professionals and integrate a change into their work processes. For that reason, a team at the University of Iowa developed the Prevention of Perioperative Hypothermia Toolkit©. Use of this toolkit has been tested for the past two years, and refined with lessons learned. The toolkit includes is a list of steps for planning the implementation of changes. The second component is a template for a risk assessment, a Healthcare Failure Mode and Effect Analysis (HFMEA), to identify potential issues that can arise during implementation. The next component is an educational program that can be modified with taped statements of support from key perioperative leaders in the setting. A list of data elements to use for modifying the electronic documentation system is included to allow for the generation of reports. And, there are spreadsheets that can be used as templates for audit and feedback.

The Prevention of Perioperative Hypothermia Toolkit© is available free of charge.

For more information, watch the 3M webinar Strategies for Infusing Evidence-based Practices for Prevention of Perioperative Hypothermia.

The Prevention of Perioperative Hypothermia (PPH) Toolkit was funded by the Agency for Healthcare Research and Quality, grant 3 IR18HS021422-01A1.

Dr. Steelman has been a perioperative nurse for over 25 years. As a perioperative advanced practice nurse at the University of Iowa Hospitals and Clinics, she focused on implementing evidence-based practice changes for 20 years. She is currently Associate Professor in the College of Nursing at the University of Iowa where she teaches graduate students evidence-based practice. Her program of research focuses on perioperative safety and quality. She has extensively published and presented about issues related safe patient care in the operating room, including five research studies focusing on prevention of retained surgical sponges. She is well recognized for her contributions and received AORN’s Outstanding Achievement awards for Research and Evidence-based Practice. In 2008, she received the AORN’s highest award, the Award for Excellence in recognition of her contributions to perioperative nursing. In 2007, she was inducted into the American Academy of Nursing in recognition of the national and global impact of her work. 

REFERENCES

1. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334:1209-1215.

2. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277:1127-1134.

3. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996;347:289-292.

4. Winkler M, Akca O, Birkenberg B, et al. Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg. 2000;91:978-984.

5. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87:1318-1323.

6. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318-338.

7. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-596.

8. Torossian A. Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol. 2008;22:659-668.

9. Sessler DI, Schroeder M. Heat loss in humans covered with cotton hospital blankets. Anesth Analg. 1993;77:73-77.

10. Fossum S, Hays J, Henson MM. A comparison study on the effects of prewarming patients in the outpatient surgery setting. J Perianesth Nurs. 2001;16:187-194.

11. Birch DW, Manouchehri N, Shi X, Hadi G, Karmali S. Heated CO(2) with or without humidification for minimally invasive abdominal surgery. Cochrane Database Syst Rev. 2011;(1):CD007821.

12. Ng SF, Oo CS, Loh KH, Lim PY, Chan YH, Ong BC. A comparative study of three warming interventions to determine the most effective in maintaining perioperative normothermia. Anesth Analg. 2003;96:171-176.

13. Borms SF, Engelen SL, Himpe DG, Suy MR, Theunissen WJ. Bair hugger forced-air warming maintains normothermia more effectively than thermo-lite insulation. J Clin Anesth. 1994;6:303-307.

14. Andrzejowski J, Hoyle J, Eapen G, Turnbull D. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Br J Anaesth. 2008;101:627-631.

15. Horn EP, Schroeder F, Gottschalk A, et al. Active warming during cesarean delivery. Anesth Analg. 2002;94:409-414.

16. Vanni SM, Braz JR, Modolo NS, Amorim RB, Rodrigues GR,Jr. Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. J Clin Anesth. 2003;15:119-125.

17. Steelman, V. M., Perkhounkova, Y. S., & Lemke, J. H. The gap between compliance with the quality performance measure “Perioperative Temperature Management” and normothermia. J Healthc Qual. 2014 January 13. PMID: 24417607. doi: 10.1111/jhq.12063.

Oct 28, 2015

Unintended Hypothermia: Do You Know the Risks?

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Unintended hypothermia remains a common—but easily preventable—complication of surgery.1 It is estimated that unintended hypothermia, defined as a core body temperature of less than 36.0°C (96.8°F), occurs in more than 50% of all US surgical patients, even those undergoing short procedures (one to one-and-a-half hours).2

Numerous studies have demonstrated that even mild perioperative hypothermia can result in significant complications. Unfortunately, temperature management of surgical patients remains a secondary consideration in many O.R.s rather than an essential standard of care.

The list of potential complications associated with unintended hypothermia is extensive. Studies of the impact of hypothermia on the incidence of wound infection have shown that the hypothermic patient is at an appreciably greater risk for wound infection than a normothermic patient.Research also demonstrates that surgical patients with cardiovascular disease who are hypothermic are three times more likely to have adverse myocardial outcomes than normothermic patients.4

Hypothermia alters the effects of many classes of drugs, including muscle relaxants and intravenous anesthetic agents. By decreasing drug metabolism, even mild hypothermia can lead to delayed awakening and require a longer PACU stay.5,6

Increased surgical bleeding has been attributed to hypothermia. In a study of hip arthroplasty patients, a decrease of 1.6°C (2.9°F) in body temperature increased blood loss and the need for allogeneic blood transfusions.7

Hypothermia has also been linked to increased mortality8, pressure ulcer development9 and increased length of hospital stay for surgical patients.1,4

There is also a significant financial benefit of reducing hypothermia rates in surgical patients. Studies have demonstrated that maintaining normothermia can result in savings of $2,500 to $7,000 per patient by eliminating the costs of hypothermia-related complications, including surgical site infections.10

The benefits—to patients, clinicians and facilities—of temperature management are clear. For more information about warming options and to find education materials, click here.

Read Target Normothermia: A Global Focus on Inadvertent Hypothermia

References
  1. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996;334:1209–1215.
  2. Young VL, Watson ME. Prevention of Perioperative Hypothermia in Plastic Surgery. Aesthetic Surgery Journal. 2006;26(5):551-571.
  3. Flores-Maldonado A, Medina-Escobedo CE. Mild perioperative hypothermia and the risk of wound infection. Arch Med Res. 2001;32(3):227-231.
  4. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277(14):1127–1134.
  5. Bissonnette B, Sessler DI. Mild hypothermia does not impair postanesthetic recovery in infants and children. Anesth Analg. 1993;76(1):168–172.
  6. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87(6):1318–1323.
  7. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996;347(8997):289–292.
  8. Barie, PS., Surgical Site Infections: Epidemiology and Prevention. Surgical Infections. Vol 3, Supplement 2002; S-9 – S-21.
  9. Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J. 2006;83(5):1090–1104, 1107-1113.
  10. Mahoney, CB. Odom, J. Maintaining intraoperative normothermia: A meta-analysis of outcomes with costs. AANA Journal. 67(2): 155-164. 1999.
Sep 3, 2015

The Science Behind Patient Warming and the Benefits of Normothermia

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Perioperative Patient Warming

Read the study summary – Target Normothermia: A Global Focus on Inadvertent Hypothermia

Thermoregulation

Under normal circumstances, the body controls its temperature within a very tight tolerance, with the core being 2-4˚C warmer than the periphery. This temperature gradient between the core and the periphery is caused by normal thermoregulatory vasoconstriction. Anesthesia induction results in vasodilation, which allows the warmer blood to flow freely from the core and mix with the blood from the cooler periphery, lowering the core body temperature. Research has shown that in the first 60 minutes under anesthesia unwarmed surgical patients can lose up to 1.6˚C1,a phenomenon known as redistribution temperature drop (RTD).

Unintended perioperative hypothermia

Unintended hypothermia remains a common—but easily preventable—complication of surgery.2 It is estimated that unintended hypothermia, defined as a core body temperature of less than 36.0°C (96.8°F), occurs in more than 50% of all US surgical patients, even those undergoing short procedures (one to one-and-a-half hours).3

Numerous studies have demonstrated that even mild perioperative hypothermia can result in significant complications. Unfortunately, temperature management of the surgical patient remains a secondary consideration in many perioperative settings rather than an essential standard of care.

Benefits of normothermia

The benefits of maintaining normothermia have been thoroughly researched and documented in independent peer-reviewed articles. A number of these studies are randomized controlled studies that document the importance of preventing hypothermia.

In a landmark meta-analysis performed by Chris Brown Mahoney, she captured the essence of earlier research which identified dramatic decreases in the complication rates and the related patient care costs that can be avoided by keeping patients normothermic. Normothermia is a process improvement that touches the entire patient care algorithm. This meta-analysis of 20 studies covering 1,575 patients identified reductions in patient costs in several different areas when normothermia is maintained such as:5

  • Reduction in the use of blood products
  • Shortened length of hospital stay
  • Decreased ICU time
  • Reduced rate of wound infection
  • Decreased likelihood of myocardial infarction
  • Lower mortality rates

There is also a significant financial benefit of reducing hypothermia rates in surgical patients. Maintaining normothermia can result in savings of $2,500 to $7,000 per patient by eliminating the costs of hypothermia-related complications, including surgical site infections.5

Study Summary: Target Normothermia: A Global Focus on Inadvertent Hypothermia

References
  1. Sessler DI, Current concepts: mild perioperative hypothermia. N Eng J Med 1997; 336: 1730-1737.
  2. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996;334:1209–1215.
  3. Young VL, Watson ME. Prevention of Perioperative Hypothermia in Plastic Surgery. Aesthetic Surgery Journal. 2006;26(5):551-571.
  4. Sessler DI, Kurz A. Mild Perioperative Hypothermia. Anesthesiology News. October 2008: 17-28.
  5. Mahoney CB, Odom J. Maintaining intraoperative normothermia: A meta-analysis of outcomes with costs. AANA Journal. 1999;67(2):155-164
Aug 6, 2015

Small Changes in Patient Warming Can Lead to Huge Gains in Patient Satisfaction

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Patient Satisfaction Patient Warming

In recent years, shifts within the healthcare industry have granted patients more authority in choosing their physicians, treatment options, and medical facilities. As a result, medical centers are quickly finding that their patients are transforming into opinionated consumers with considerable buying power. This shift has created a newfound respect for patient satisfaction; after all, a satisfied customer is more likely a repeat customer who generates even more business through referrals.

In many cases, efforts to improve patient satisfaction have focused on superficial levels, such as gourmet coffee and attractive waiting rooms. However, these endeavors can only influence a patient’s perception of care, rather than actual experience or outcome. To secure long-term growth and meet quality measures, it may be wiser to look for investments can enhance both the patient’s experience and outcomes.

In some cases, a small change can bring about dramatic effects. Replacing standard hospital gowns with a forced-air warming gown can boost patient satisfaction and comfort. In addition, forced-air warming can reduce patient anxiety, which is correlated with fewer interventions, a better overall experience, and, in some cases, requiring less anesthesia1. During the surgery itself, patient warming helps to sustain normothermia, which can lead to a reduction in the rate of infection, shorter hospital stays, and lower mortality rates, among other effects2.

As patient satisfaction becomes more closely tied to organization’s pay-for-performance measures, improvements with the potential for a high return on investment—such as patient warming—should become a priority for improved patient experience and clinical outcomes.

References:

1. Wagner D. Byrne M and Kolcaba K. Effects of comfort warming on preoperative patients. AORN Journal. Sept. 2006.

2. Mahoney CB and Odom J. Maintaining intraoperative normothermia: A meta-analysis of outcomes with costs. AANA J. 67(2):155-164. 1999.