Quality statement 3: Patient temperature

Quality statement

Adults having surgery under general or regional anaesthesia have normothermia maintained before, during (unless active cooling is part of the procedure) and after surgery.

Rationale

During surgery patients are kept in a stable condition by the operating team. All tissues heal most effectively in optimal conditions of oxygenation, perfusion and body temperature. Inadvertent perioperative hypothermia is a common but preventable complication of perioperative procedures that is associated with an increased risk of surgical site infection and other postoperative complications. Surgical patients are at risk of developing hypothermia before, during or after surgery. Maintaining normothermia throughout this period (except if cooling is required for medical reasons) will therefore reduce the risk of infection at the surgical site and ensure that patients feel comfortably warm at all times.

Quality measures

Structure

Evidence of local arrangements to ensure that adults having surgery under general or regional anaesthesia have normothermia maintained before, during (unless active cooling is part of the procedure) and after surgery.

Data source: Local data collection.

Process

Proportion of surgical procedures on adults under general or regional anaesthesia in which the person having surgery has their core temperature measured and documented in accordance with Hypothermia: prevention and management in adults having surgery (NICE clinical guideline 65).

Numerator – the number in the denominator in which the person having surgery has their core temperature measured and documented in accordance with Hypothermia: prevention and management in adults having surgery (NICE clinical guideline 65).

Denominator – the number of surgical procedures on adults under general or regional anaesthesia.

Data source: Local data collection.

Outcome

Proportion of surgical procedures on adults under general or regional anaesthesia in which the person having surgery is normothermic before, during (unless active cooling is part of the procedure) and after surgery.

Numerator – the number in the denominator in which the person having surgery is normothermic before, during (unless active cooling is part of the procedure) and after surgery.

Denominator – the number of surgical procedures on adults under general or regional anaesthesia.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that systems are in place to measure and document core temperature in accordance with Hypothermia: prevention and management in adults having surgery (NICE clinical guideline 65) and maintain normothermia for adults having surgery under general or regional anaesthesia before, during (unless active cooling is part of the procedure) and after surgery.

Healthcare professionals measure and document core temperature in accordance with Hypothermia: prevention and management in adults having surgery (NICE clinical guideline 65) and maintain normothermia for adults having surgery under general or regional anaesthesia before, during (unless active cooling is part of the procedure) and after surgery.

Commissioners commission services from service providers that can demonstrate arrangements to ensure that they maintain normothermia for adults having surgery under general or regional anaesthesia before, during (unless active cooling is part of the procedure) and after surgery.

What the quality statement means for patients, service users and carers

Adults having an operation under a general anaesthetic or a regional anaesthetic (which affects a large part of the body, such as a limb or the lower half of the body) are kept comfortably warm (at normal body temperature) before, during and after the operation to help reduce the risk of infection.

Source guidance

Surgical site infections: prevention and treatment (2008) NICE clinical guideline 74, recommendation 1.3.10

Definitions of terms used in this quality statement

The following definitions have been adapted from NICE clinical guideline 65:

Adults

People aged 18 years and over.

Regional anaesthesia

Central neuraxial block.

Normothermia

A core temperature range of 36.5°C to 37.5°C.

Before surgery

The preoperative phase, defined as 1 hour before induction of anaesthesia (when the patient is prepared for surgery on the ward or in the emergency department).

During surgery

The intraoperative phase, defined as total anaesthesia time (including the time in the anaesthetic room before induction of anaesthesia).

After surgery

The postoperative period, defined as 24 hours after entry into the recovery area (which will include transfer to and time spent on the ward).

Perioperative pathway

The continuous period of the preoperative, intraoperative and postoperative phases.

Measurement and documentation of core temperature

In accordance with NICE clinical guideline 65, measure and document core temperature:

  • in the hour before the patient leaves the ward or emergency department [recommendation 1.2.2]

  • again before induction of anaesthesia and then every 30 minutes until the end of surgery [recommendation 1.3.1 (key priority for implementation)]

  • on admission to the recovery room and then every 15 minutes [recommendation 1.4.1 (key priority for implementation)]

  • on arrival at the ward [recommendation 1.4.2]

  • every 4 hours on the ward [recommendation 1.4.2].

This quality statement does not cover people undergoing therapeutic hypothermia or people with severe head injuries resulting in impaired temperature control. Other exclusions may apply at certain points on the perioperative pathway, such as when surgery needs to be expedited for clinical urgency. Hypothermia: prevention and management in adults having surgery (NICE clinical guideline 65) does not cover children and young people (aged less than 18 years), pregnant women or people undergoing local anaesthesia, but it is recognised that users of the quality standard may wish to consider how the quality statement on normothermia may apply to these groups.

Equality and diversity considerations

This quality statement may not apply to all pregnant women, because they are not covered by NICE clinical guideline 65. Because of the physiological changes in pregnancy, the needs of pregnant women may need to be considered separately from non-pregnant women for some types or aspects of surgery. Similarly, NICE clinical guideline 65 does not cover children (aged less than 18 years). Users of the quality standard will need to apply clinical judgement in considering how the quality statement on patient temperature applies to these groups.