P1.242: Improvement in Thermoregulation Practices for Neonatal Surgeries

Purpose/Objectives: A quality project between the Department of Pediatric Anesthesia and the Neonatal Intensive Care Unit (NICU) was developed to standardize and ensure appropriate thermoregulation in the operating room and the perioperative period. Previous surgical chart reviews from 2018 revealed abnormal intraoperative temperatures in up to 70% of cases. The temperatures improved in subsequent years, however in 2023, a decrease in normal intraoperative temperatures was noted with inconsistency in interventions used to appropriately regulate temperatures during the intraoperative period. The purpose of this initiative was to improve intraoperative normothermia by 10% between Jan 2023 and January 2024.

Design/Methods: The first PDSA cycle in early 2023 included chart reviews to evaluate temperature documentation every 15 minutes and temperatures in the perioperative period. Opportunities for improvement were shared with the Chief of Pediatric Anesthesia for review and shared with the Department of Anesthesia and Pediatric Quality Committee. Regional Quality distributes letters to the anesthesiologist with fall outs. A Neonatal Surgical QAPI committee was formed in September 2023 where all surgical cases were reviewed. This team specifically reviews surgical fall outs and identifies additional opportunities to improve thermoregulation during surgery. PDSA cycles included a reminder tool for surgical temperatures, re-education of surgical binder, and evaluation of environmental temperatures in the operating room.

Results: In 2023, a decrease in normal intraoperative temperatures was noted with a median of 70%. Despite this decrease, immediate postoperative temperatures were normal >80% of the time. There was a 10% improvement in normothermic intraoperative temperatures in September 2023 which has been maintained in 2024. There was also an improvement in median compliance rates in the intervention documentation and vital sign documentation from 39% in 2023 to 100% in 2024.

Conclusion/Discussion: Thermoregulation for the surgical patient in the neonatal population can be difficult to maintain. The ability of a medical team to achieve normothermia in the operative and perioperative period improves with frequent temperature assessments, standardized interventions for hypothermia, evaluation of the environmental temperature, and multidisciplinary approach to review of surgical cases. Plans for future PDSA cycles include standardization of operating room environmental temperatures and creation of a flow diagram for recommended interventions and more rapid follow up to achieve target temperature range during the intraoperative period.