18 - Sustainable Normothermia Management with Financial Impact in Ophthalmology MAC Cases

Description: Maintaining normothermia (36-38°C/96.8-100.4°F) throughout the phases of perioperative care has many advantages and is a patient satisfier. However, products used to support normothermia can be cost prohibitive and can negatively impact the environment. At the University of Wisconsin Hospitals and Clinics (UW Health), all patients receive a pre-op warming gown prior to their surgery and is used to prevent hypothermia commonly caused by anesthesia induction. Pre-op active warming gowns are a one patient use product and product specifications list the material as "soft flannel-like Opaque material."
The Green OR Council worked collaboratively with clinical nurse specialists (CNS), and infection prevention across several UW Health locations to investigate organization normothermia practices. It was discovered majority of adult patients received an active warming gown while a very small group received a linen gown pre-operatively. The cost of the standard sized active warming gown is $13.23 each and extra-large is $17.23 each compared to linen gowns, $0.65 each and $0.73 each respectively. Given the range in cost, the Council identified a cost savings and waste reduction opportunity and reviewed cases with monitored anesthesia care (MAC). MAC has less of an impact on a patient's ability to thermoregulate, therefore encouraging the Council to review and focus on these types of cases.
Most MAC cases at UW Health are ophthalmology, in which the council identified as the surgical specialty to pilot the use of the linen gown and monitor effect on patient thermoregulation. A 3-week pilot was performed where a linen gown was provided to ophthalmology patients scheduled with MAC for a procedure 60 minutes or less. Of 62 patients, 60 patients were normothermic pre-operatively (2 patients did not have pre-op temperatures documented) and 59 patients were normothermic post-operatively (2 patients required active warming and 1 patient did not have a temperature documented). While 48 of these patients had active warming gowns documented pre-operatively, when the CNS followed up with pre-operative staff, it was identified the documentation of the gown was incorrect and no patient had received a warming gown unless the patient was hypothermic. With positive results, the pilot was expanded to all ophthalmology cases scheduled with MAC and removing the 60 minute or less time requirement. During a consecutive two-week timeframe with broadened criteria, 44 of the 45 patients were normothermic pre-op (1 patient did not have pre-op temperature documented) and 45 patients were normothermic post-op.
The Council identified staff providing care were not aware of all products available which resulted in the creation and dissemination of a resource document to support staff knowledge of normothermia and products available to maintain or initiate active warming when indicated.
While a small number of patients required active warming, majority of the patients were able to thermoregulate without requiring an active warming gown pre-operatively and post-operatively, reducing waste of a one-time use product and cost savings. The Council identified this as a successful pilot and worked to implement the practice for MAC ophthalmology cases at other UW Health Locations.