Prevent Perioperative Hypothermia Use continuous patient temperature monitoring BY MARY LETOURNEAU, RN

With the ever-increasing number of complex sur- geries performed in ASCs today, patients are under general or neuraxial anes-

thesia for longer periods of time than before. Thermoregulatory control is compromised during these surgical procedures and could potentially lead to Perioperative Hypothermia or PH. PH is considered a periopera-

tive complication, and patients who receive neuraxial and general anesthe- sia could be at risk. PH can be defined as a core body temperature dropping below 36 degrees

Celsius or 96.8

degrees Fahrenheit during surgery. Even mild to moderate PH can be associated with increased susceptibil- ity to cardiovascular stress, infection and impaired coagulation, as well as post-anesthetic shivering and discom- fort. Thus, continuously monitoring a patient’s temperature during the entire surgical process is a good option to assess the patient for normothermia. In the event a patient’s core temper- ature becomes hypothermic, external active warming interventions might not be enough to restore the patient’s temperature to normothermia due to the time it could take to rewarm the core tissues. Therefore, to ensure nor- mothermia in the surgical patient under anesthesia, care providers should focus on implementing proactive tempera- ture monitoring measures rather than reactive temperature taking methods such as event-based thermometers.

ASC-13 Normothermia, a CMS Quality Measure The ASC-13: Normothermia Outcome measure requires ASCs that want to receive full Medicare reimbursement to submit temperature data for qual-

The key to continuous temperature monitoring is to select a site that provides consistent measurement without interruption.”

— Mary LeTourneau, RN, RG Medical Diagnostics

ified patients beginning in 2020. The Centers for Medicare & Medicaid Ser- vices (CMS) adopted the measure as a part of its final 2017 ASC Payment Rule released in November 2016. This measure focuses on patients under general or neuraxial anesthesia for 60 minutes or longer. The effects of anes- thesia cause the surgical patient’s body temperature to fall and result in pri- mary hypothermia, which is further impacted by the cooler environment to cause secondary hypothermia. After anesthesia is administered it is normal to register a reduction in the patient’s temperature. Other environ- mental factors also can influence a drop in core body temperature, thus, the surgical team will need to be vig- ilant in lessening those factors by, for instance, keeping the operating room at the optimal temperature. Both the Association of periOpera- tive Registered Nurses (AORN) and

the American Society of PeriAnesthe- sia Nurses (ASPAN) guidelines state that every patient undergoing surgery is at risk for developing PH and that a surgical patient’s temperatures should be monitored from preop through post- anesthesia care unit (PACU). By initi- ating the practice of temperature mon- itoring in preop, the surgical team can ascertain the patient baseline before anesthesia. Patient temperatures aver- aging 1.5 degrees Celsius or 2.7 degrees Fahrenheit below normal could cause negative patient outcomes, according to the article, “Preoperative Interventions for Prevention of Hypothermia” in the March 2017 issue of Anesthesia eJour- nal. Finally, monitoring patient tem- peratures from preop through PACU allows the surgical team to quickly note any change in temperature and respond accordingly using established protocols within their ASC.

The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion. 22 ASC FOCUS NOVEMBER/DECEMBER 2019|

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