Preventing perioperative hypothermia is clinically feasible and cost effective

This Article is brought to you for free and open access by Journal of Perioperative Nursing. It has been accepted for inclusion in Journal of Perioperative Nursing by an authorized editor of Journal of Perioperative Nursing. Recommended Citation Ralph, Nicholas (2019) "Preventing perioperative hypothermia is clinically feasible and cost effective," Journal of Perioperative Nursing: Vol. 32 : Iss. 1 , Article 1. Available at: https://doi.org/10.26550/2209-1092.1051


ACORN
The Australian College of Perioperative Nurses (ACORN) is a registered Australian company and health promotion charity.It exists to serve its members, the perioperative profession, the patient and the community to promote the prevention and control of disease.
ACORN's vision is for Australian patients to receive the safest and highest quality evidence-based perioperative care in the world.

Recent developments in thermal care
The United Kingdom National Institute for Health and Clinical Excellence (NICE) has published a guideline 'Perioperative hypothermia (inadvertent): The management of inadvertent perioperative hypothermia in adults' detailing appropriate perioperative thermal management to minimise the occurrence of perioperative hypothermia.The guideline is based on a comprehensive systematic review including both meta-analysis and cost-effectiveness analysis 4 .
Recommendations from the guideline include the requirement for preoperative hypothermia risk assessment, regular temperature monitoring, and active and passive warming strategies.However, compliance with recommendations in clinical practice is poor despite their relative simplicity and costeffectiveness.For example, results from a large European multisite observational study (n = 8083) conducted prior to the NICE guideline development found that temperature monitoring was not appropriately undertaken in 81 per cent of patients 5 .Both the Australian and New Zealand College of Anaesthetists and the Royal Australasian College of Surgeons clinical guidelines reflect the recommendations of the NICE guideline 3 .
In 2014 a thermal care bundle was developed by a panel of Australian expert clinicians and researchers to improve the prevention, detection and treatment of perioperative hypothermia in adult surgical patients 6,7 .Implementing a thermal care bundle can help rapidly disseminate optimal clinical guidelines for the management of health care-associated illnesses and risks.The bundle elements were selected from the NICE guideline on the management of perioperative hypothermia in adults.

Economics of preventing perioperative hypothermia
In a report soon to be released, the authors will provide a detailed economic analysis on the costeffectiveness of preventing inadvertent perioperative hypothermia in Australia.Using rigorous up-to-date data, the authors report findings based on a scenario of 80 per cent compliance with guidelines effective for reducing perioperative hypothermia.They found that the total cost of perioperative hypothermia to the Australian health system is $1.26 billion and that preventing perioperative hypothermia has an annual net benefit of: • $602 million to the Australian health system • approximately $7085 per patient for major surgery (with an overnight stay) from reducing SSIs alone • approximately $6560 per patient for minor surgery (with an overnight stay) from reducing SSIs alone.
This report is of significance to all perioperative nurses in Australia as the prevention of hypothermia is often led by nurses and denotes the value of high reliability nursing care.Significantly, the authors recommend that: • current best practice is adopted ensuring that thermal care is provided to 'every patient, every time' • a national multidisciplinary-based policy for preventing and managing perioperative hypothermia is developed • a definitive clinical trial on perioperative hypothermia is conducted.
With the release of this report expected in the first half of 2019, we encourage all perioperative nurses to take heart in recognising the significant value they provide to the Australian health care system by delivering excellent perioperative care.