Hospital in Southport, N.C. She learned this lesson the hard way while
working at her last job, as a circulating nurse with a different medical
center in North Carolina.
"We were doing a good job of warming patients post-operatively, but
by then we were playing catch-up," she says. "We had a number of
patients in PACU that were cold. After evaluating what was going on,
we found out not enough people [on staff] knew about the dangers of
perioperative hypothermia."
The hospital was using forced-air warming blankets intra-operative-
ly as its primary mode of maintaining normothermia, but it wasn't
quite enough. Ms. York says more than 90% of the facility's patients
were "adequately warm" when they arrived in PACU, but the remain-
ing patients were hypothermic. So she did something about it.
Her "project," as she calls it, was to revamp the hospital's culture.
She began with a thorough evaluation of current perioperative
processes, followed by educational outreach to all perioperative serv-
ices personnel and follow-ups to ensure staff compliance. In other
words, managing hypothermia earlier into the process became a team
mission. The result: normothermia in 100% of patients.
Solving problems
How did they get there? The turnaround started in pre-admissions,
where staffers were asked to educate patients about the risks associ-
ated with hypothermia and the need for active warming. But, as Ms.
York remembers it, "the bulk of the problems" were in pre-op.
In the course of the process review, Ms. York learned that mem-
bers of the housekeeping staff would turn down the temperatures in
each room when they came in to clean at the end of each day, mean-
ing a.m. patients arrived in a cold room — and it stayed cold
throughout the day unless patients spoke up.
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