Barriers to Accurate Postoperative Temperature Assessment

Abstract

In the modern era of technological advancement, it is unfortunate that an extremely high percentage of perioperative patients experience hypothermia (< 36 C). The effects of hypothermia, even transient, are well documented and include decreased wound healing, increased risk of infection, increased risk of a cardiac event, increased oxygen demand, and decreased coagulation with increased bleeding. There are several measures in place to minimize the hypothermic patient in all stages of perioperative care. Postoperatively the assessment to determine the need for intervention frequently comes from measuring the patient’s temperature with a temporal artery thermometer. The purpose of this study was to identify the factors that motivate PACU nurses and anesthesia providers, at a hospital in rural Southeastern Arizona, to take multiple temperature recordings on postoperative surgical patients prior to recording the temperature in the patient’s medical record. Using the Promoting Action on Research Implementation in Health Services (PARIHS) Framework, the elements of evidence (E), context (C), and facilitation (F) are areas that need attention and can be identified in order to achieve successful implementation of action (SI) (SI=f (E,C,F) ). After University of Arizona IRB approval (Appendix A), one on one interviews were performed with eight (n=8) eligible participants. The interviews were semi-structured with seven open-ended questions to allow the respondent to expound on relevant topics. The questions were categorized based on the PARIHS elements. Content analysis was conducted on each question taking in all eight participant responses. Each element showed common content where improvement should be considered using the available evidence. Results showed a trend toward an inaccurate tool for measurement coupled with a perceived pressure from anesthesia providers to produce certain results. Changes in policies and procedure could serve to improve the process and in turn improve the quality of patient care.