Quality standard
Quality statement 3: Patient temperature
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
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
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 NICE's guideline on hypothermia: prevention and management in adults having surgery.
Numerator – the number in the denominator in which the person having surgery has their core temperature measured and documented in accordance with NICE's guideline on hypothermia: prevention and management in adults having surgery.
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 different audiences
Service providers ensure that systems are in place to measure and document core temperature in accordance with NICE's guideline on hypothermia: prevention and management in adults having surgery 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 NICE's guideline on hypothermia: prevention and management in adults having surgery 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.
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. NICE guideline NG125 (2019), recommendation 1.3.12
Definitions of terms used in this quality statement
The following definitions have been adapted from NICE's guideline on hypothermia: prevention and management in adults having surgery.
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's guideline on hypothermia: prevention and management in adults having surgery, measure and document core temperature:
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in the hour before the patient leaves the ward or emergency department [recommendation 1.2.2]
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again before induction of anaesthesia and then every 30 minutes until the end of surgery [recommendation 1.3.1 (key priority for implementation)]
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on admission to the recovery room and then every 15 minutes [recommendation 1.4.1 (key priority for implementation)]
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on arrival at the ward [recommendation 1.4.2]
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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. NICE's guideline on hypothermia: prevention and management in adults having surgery 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's guideline on hypothermia: prevention and management in adults having surgery. 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, the guideline 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.