Associate Professor University of Mississippi Medical Center Madison, Mississippi, United States
Background: The Neonatal Intensive Care Unit (NICU) at Children’s of Mississippi is a level IV NICU in a tertiary academic medical center with approximately 3000 deliveries and 1000 NICU admissions annually. About 20-25 infants undergo surgical procedures in the operating room (OR) under general anesthesia every month. Perioperative hypothermia is associated with several complications, including surgical site infections, blood loss, coagulopathy, discomfort, altered vital signs, and prolonged recovery time. The primary purpose of this project is to reduce perioperative morbidity among all NICU infants returning from the OR by optimizing perioperative temperature. Objective: SMART
Aim: Increase the percentage of normothermic (97.7 ◦F - 99.5 ◦F) post-operative NICU patients from 42% to 62% by June 2022. Primary Outcome Measure: Percentage of babies with Normothermia Design/Methods: PDSA cycles: A multidisciplinary team developed a driver diagram, identified change ideas, and conducted PDSA cycles over 18 months despite challenges during the COVID pandemic. Normothermia is defined as a temperature between 97.7 ◦F - 99.5◦F. PDSA cycle 1: Standardization of mode of transport. A flow chart based on patient weight and gestational age was developed. Multiple educational sessions were held with all stakeholders, and they received hands-on training on setting up the isolette temperatures and using warming devices. PDSA cycle 2: Timing of temperature measurements. The definition of normothermia was standardized, and nursing education was completed. Identified deficiency with the timing of temperature measurements prior to departure from the NICU. A visual reminder (not frosty/not toasty) as a flyer was posted in strategic locations across the NICU, discussed at unit meetings and shared via email. PDSA cycle 3: Standardization of intraoperative environmental temperature. Collaborating with the peri-operative and infection prevention teams, the intraoperative temperature was standardized to 72°F for all infant surgeries. Education was provided to both anesthesia and surgery teams. Results: Over the course of this project, change ideas implemented by the multidisciplinary team resulted in a sustained improvement in the incidence of normothermia in NICU patients undergoing surgical procedures in the OR.
Conclusion(s): We present data on the primary outcome measure and are in the process of analyzing data and examining other key measures. This multidisciplinary effort has resulted in the standardization of multiple perioperative processes and improved the percentage of babies with perioperative normothermia.
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