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Angela Wetli
Nur 4242
Wendi Liverman
I pledge.
Introduction
each surgical patient is safely cared for and given the best experience
among others, and may result in a longer hospital stay (Bashaw, 2016, p.
IV fluids to the patients. Currently the St Francis Eastside does not have a
fluid warmer in the preop unit. The goal of this change project is to prove
is placed on each patient that has a surgery time of greater than 60 minutes.
and continuing on until recovery. Also, every effort is made to keep each
warm. However, one intervention that is not used is warm fluids during preop
participants given room temperature intravenous fluids at 30, 60, 90, and
120 minutes, and at the end of surgery (Campbell, Alderson, Smith, &
FINAL SUMMARY REPORT 3
Warttig, p. 3). There are patients that come to the recovery room that have a
Explanation of Project
to use room temperature IV fluids on each surgical patient in the preop area.
There is a fluid warmer on the unit, but it is located in the center OR core. It
not convenient for the preop nurses. The temperatures of 8 patients were
take using room temperature fluids. The patients temperature preop and
then the temperature following the surgery. Four of the eight patients in the
study were hypothermic upon entering the recovery room. This process
currently needs improvement. This change project will show the need to
update this process and purchase a fluid warmer for the preop area. It has
& Harper, 2014, p. 624). The table below shows the temperatures of eight
Table 1
Salpingectomy
Sleeve 2 hours 97.5 97.1 None reported
Gastrectomy
Breast 1 hour 97.9 96.1 None reported
Lumpectomy
Abdominal 1.5 hours 98.6 97.0 None reported
Laparoscopy
Total Knee
1.75hours 98.3 98.8 None reported
Arthroplasty
The new process that was tested during this project was to provide
warm IV fluids for 8 select patients that had a surgery time of greater than
hysterectomy patients. One barrier that was encountered during this initial
test cycle was there was very few hysterectomy patients scheduled during
this week. Other surgical patients had to be included in the test. The preop
The warm IV fluids were taken from the operating room fluid warmer,
which is not very convenient to preop staff. It requires the preop nurse to
place an OR hat and mask on in order to go to the OR center core to get the
warm fluids. There are limited number of fluids and they are also being used
by the OR staff to administer during the cases. This was also a barrier to the
project because the fluids needed to be restocked more often and there was
not a person assigned to this task. The preop nurse had to ensure that the
FINAL SUMMARY REPORT 5
fluids were replaced in order to have enough stock. The overall process of
having to retrieve a warm fluid for each patient from the OR area makes the
nurses in preop less efficient. If a fluid warmer was purchased for the preop
patients that will receive greater than 500ml of fluid. This would include all
celcius (98.6 degrees Fahrenheit) prevents heat loss from the administration
The predictions that were made prior to the implementation were that
infections.
Implementation
Temperatures were taken by the preop nurses and recorded. Warm IV fluids
were were given to each of these patients. Each preop nurse had to prepare
the warm fluids from the OR fluid warmer for each individual patient. This
process makes the preop team less efficient. Following surgery the each of
FINAL SUMMARY REPORT 6
the patients temperatures were taken by the recovery room staff and
Table 2
As shown in the table, there are two patients that were admitted to the
Despite administering warm fluids in the preop area, these patients were still
too cold. Of all of the patients reported only 1 patient had significant
postoperative shivers in the recovery room. None of the patients that were
the predicted goal. The goal was to have 100% of the patients entering
recovery room without any signs of hypothermia. There were still two
patients that were too cold after surgery. However, there was only one
patient that was shivering after surgery, which is an improvement. There are
Another barrier that was encountered was the cost to provide the
counter top fluid warmer is $6484. A floor standing fluid warmer, which
would be ideal, costs $8218. The supervisor over the preop unit stated that
this was not in the current capital budget for this year. However, the preop
charge nurse suggested that there was a fluid warmer that was not being
currently used in a different department. She was able to get the approval to
that have a surgery time of greater than 60 minutes will be included. The
fluid warmer from the OR will be stocked more frequently by the preop
nurses in order to provide adequate fluids for preop and the operating room.
The temperatures will be taken in preop and upon entry to recovery room.
Conclusion
In conclusion, there were barriers that were faced during the planning
and implementation of the test cycle. The patients that were to be included
in the test had to be altered and the administering the warm fluids was a
on admission to the PACU. Using warm fluids on the preop patients did
the test was that 100% of the patients would have a normal temperature
following surgery. This was not the case since two of the patients still had a
low temperature, but the overall percentage did improve. The percentage of
patients that had postop shivers was also decreased. There were no
the managers of the department have approved the change. The process will
begin once the fluid warmer is in the preop area. The budget was not
approved to buy a new fluid warmer, but the preop charge nurse was able to
find a fluid warmer in another department that was not being used.
warmer and an equipment check was done on the actual warmer. The
the area where the warmer will be placed. An estimate will be given to
FINAL SUMMARY REPORT 9
pending.
References
http://dx.doi.org/10.1016/j.aorn.2016.01.009
Campbell, G., Alderson, P., Smith, A. F., & Warttig, S. Warming of intravenous
Health Services Advisory Group. (n.d.). Turn up the heat: Avoiding surgical
https://www.medlineuniversity.com/lms/course/1010000371/?
tabId=62&moduleId=144&GoBackTo=D06550C
John, M., Ford, J., & Harper, M. (2014, February 1). Peri-operative warming
http://dx.doi.org/10.1111/anae.12626