Speakers
Ms. Peggy TSUNG
Nurse Consultant
Perioperative Care
New Territories East Cluster
Hong Kong
Ms. Peggy TSUNG is the Nurse Consultant of Perioperative Care in the New Territories East Cluster. She became a Registered Nurse in 1992 and started working in the Operating Theatre of the Prince of Wales Hospital since then. She was promoted to Nurse Consultant in 2013. Striving to diversify her nursing specialty, she has been expanding the role and responsibility of the perioperative nursing profession during her career as a Nurse Consultant. Among her achievements, the establishment of Nurse Pre-anaesthetic Assessment Clinic and post-operative nurse-led discharge are of the highest significance. In recent years, she has been focusing on promoting evidence-based practice in her specialty, especially in pre-operative warming.
Tsung PPK1, Chim TL2, Tong DWK3
(1) Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong
(2) Anaesthesia and Operating Theatre Services, Pok Oi Hospital, Hong Kong
(3) Nursing Services Department, Hospital Authority Head Office, Hong Kong
Background
Post-operative hypothermia is a predisposing factor of surgical complications. Pre-operative warming for ≥ 10 minutes may reduce post-operative hypothermia. This CQI project aimed to identify the risks factors for post-operative hypothermia, evaluate the effectiveness of pre-operative warming and promote corporate practice implementation.
Methodology
Eighteen operating theatres in 17 hospitals joined the project. Pre-operative warming was implemented in November 2019. Adult patients undergoing elective colorectal, urological and thoracic surgeries with general or spinal anaesthesia were warmed for ≥ 10 minutes pre-operatively. Post-operative hypothermia was defined as temperature below 36°C at 5 minutes after arrival to post-anaesthetic care unit. A control group consisting of similar patients in November 2018 was used.
Results
Nine hundred sixteen patients in November 2019 and 996 in November 2018 were recruited. It was subsequently found that 4 out of the 18 operating theatres had the same pre-operative warming protocol implemented in November 2018. Therefore, 373 patients from these 4 operating theatres were grouped into the implementation group. Univariate analysis revealed implementation of pre-operative warming, male gender, age ˃ 70, body mass index (BMI) ≤ 23 and blood loss > 300ml significantly associated with post-operative hypothermia. As there were substantial missing data in BMI and blood loss, they were not included in the subsequent multivariate analysis. Consequently, implementation of pre-operative warming, male gender and age > 70 were found to be independent factors associated with post-operative hypothermia. A subgroup analysis of the patients operated in November 2019 showed pre-operative warming performance was also an independent factor that could reduce post-operative hypothermia. The benefit of pre-operative warming was most obvious in urology cases.
Conclusion
Male gender and age > 70 were risk factors for post-operative hypothermia. Implementation and performance of pre-operative warming reduced post-operative hypothermia. The benefit of pre-operative warming was most obvious in urology cases.
