Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Chiu GS (1), Leung MY (2), CHAN E (1), Lee WM (1), Wong KYZ (1), Wong W (1), Wong SCM (1), Jalal K (1), SIU HY (2), Chow YK (2), Chan W (2), Wong KYK (3), Chan HYI (3).
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital.
(2) Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital
(3) Department of Surgery, Queen Mary Hospital
Introduction :
Infants are at risk of hypothermia as they have a higher body surface to weight ratio, high transepidermal permeability and inadequate subcutaneous fat. Increased risk of hypothermia when infants undergo surgery in the operating theatre (OT) due to the cool environmental setting and the general anaesthesia procedure. Definition of hypothermia according to WHO, is axillary temperature <36.5℃. In 2021, two ELBW infants’ temperature had recorded significant hypothermia with axillary temperature < 35oC upon arrival to NICU after operation and required medical interventions. These had brought the attention to the clinical team. A quality improvement project aimed at reducing hypothermia in infants throughout the process of pre-/ intra-/ post-operation and on arrival to NICU was conducted
Objectives :
1. To implement improvement strategies to maintain the temperature within normal range in infants requiring operation through cross-departmental collaborative efforts.
2. To standardize the workflow for enhancing the thermoregulation of neonates in both NICU and OT.
3. To reduce the incidence of postoperative hypothermia in infants by 50% in 18 months.
Methodology :
A Quasi-Experimental design study was conducted to evaluate the effectiveness of implementing the standardized workflow and checklist on reducing perioperative hypothermia. Retrospective chart reviews from electronic clinical information system in OT and NICU were performed during the pre-intervention review period (1/1/2019 till 8/11/2021) and post-intervention review period (16/11/2021 till 11/6/2023). The definition of hypothermia by WHO and post-operative axillary temperature were adopted. Multi-disciplinary team discussions were held to identify possible gaps leading to intra-operative hypothermia prior to interventions.
Interventions: Enhancement educational activity on neonatal thermoregulation was given. Development and implementation of nurse initiative thermoregulation standardized workflow and checklist in both NICU and OT were conducted. Pathway adjustment according to infants’ body weight at OT was carry out after intermediate review (6/7/2022)
Outcome measurement: Demographics data was collected and recorded. Primary outcome was infant’s post-operative axillary temperature within 30 minutes on arrival to NICU from OT. Secondary outcome included intraoperative temperature, relationship between patient or clinical characteristics and hypothermia. Data was input and analysed using IBM SPSS version 26. Descriptive analysis was performed, including means, standard deviations (SD)for continuous variables, and frequencies and percentage for categorical variables. Mean difference of the pre- and post-interventions temperatures between subjects and control were analysed with the unpaired samples t-test.
Result & Outcome :
81 episodes (pre-intervention) and 49 episodes (post-intervention) of neonatal surgeries were reviewed and analysed. Episodes of postoperative hypothermia were significant decreased from 57% to 20% (p<0.0001). Body weight at operation was break down into 4 groups for calculation. Intermediate review conducted at 6/7/2022, significant relationship shown between hypothermia and body weight at OT and/ or intra-operative blood transfusion. And there was 12/27 episodes (44%) of intraoperative hyperthermia captured during the intermediate period, discussion with OT nurse was held to share the findings and pathway adjustment was made. In the review held on 11/6/2023, there are no significant relationship between hypothermia and body weight at OT. Therefore, perioperative hypothermia could be significantly reduced by implementing the improvement strategies through multidisciplinary collaboration. Continuous review and pathway adjustment could maintain infants’ normothermia among all infants with different body weight at OT.
