《Audit Support.doc》由会员分享，可在线阅读，更多相关《Audit Support.doc（14页珍藏版）》请在三一办公上搜索。
1、NICE clinical guideline 65Inadvertent perioperative hypothermiaAudit supportIssue date: 2008Objective of the auditThe objective of this audit is to measure current practice in perioperative hypothermia against the recommendations in the guideline. The audit criteria and data collection tool are inte
2、nded to be used as part of a local audit project, by either using the whole tool or relevant parts within a local audit template.Audit criteria and standardsThis document provides audit criteria based on the guidelines key priorities for implementation for use in clinical audit. Users can cut and pa
3、ste these criteria into their own programmes. The standards given are typically 100% or 0%. If these are not achievable in the short term, a more appropriate standard should be set based on discussions with local clinicians. However, the standards given remain the ultimate objective.Data collection
4、toolA tool is provided that can be used or adapted by the Trust, service or practice for the data collection part of the clinical audit cycle. The tool is in two sections. The first is based on the key priorities for implementation relating to clinical activity and the second on those relating to or
5、ganisational priorities. Suggestions on where you might find relevant information are included, although this may be different in your organisation. Patient groups and sampleThe patient group relevant to this audit is people over 18 years undergoing elective and emergency surgery (including surgery
6、for trauma), under general and regional (central neuraxial block) anaesthesia at risk of or with inadvertent perioperative hypothermia. An appropriate sample should be selected in line with your local clinical audit strategy.Data sourcesThe audit criteria may require data to be collected from a rang
7、e of sources, including policy documents and patient records. Suggestions are indicated on the tools.Re-auditWhether or not the audit findings meet the standard, re-auditing is a key part of the audit cycle. If the first data collection and analysis shows room for improvement, an action plan should
8、be developed and the audit re-run once changes to the service have had time to make an impact. Depending on the nature of the changes, this could take weeks or months. This process should be continued until the results of the audit meet the standards.Further guidanceClick here for further guidance a
9、nd generic templates to support the reporting and monitoring of the audit of NICE guidance in your organisation.Perioperative careCriterion 1Patients should be offered written information about: the treatment and care they should be offered, including the Understanding NICE guidance booklet the serv
10、ice providing their treatment and care the importance of staying warm before surgery to lower the risk of postoperative complications the possibility of the hospital environment being colder than their home bringing additional clothing, such as a dressing gown, vest, warm clothing and slippers, to h
11、elp them keep warm comfortably the importance of telling staff if they feel cold at any time during their hospital stay.ExceptionsNoneSettingsAllStandard100%DefinitionsPatients should be offered written information to help them make informed decisions about their healthcare. This should cover the co
12、ndition, treatments and the health service providing care. Information should be available in formats appropriate to the individual, taking into account language, age, and physical, sensory or learning disabilities.Recommendation No.Patient-centred care/1.1.1Criterion 2Families and carers should be
13、offered written information about: the treatment and care the patient should be offered, including the Understanding NICE guidance booklet the service providing the patients treatment and care the importance of staying warm before surgery to lower the risk of postoperative complications the possibil
14、ity of the hospital environment being colder than their home bringing additional clothing, such as a dressing gown, vest, warm clothing and slippers, to help them keep warm comfortably the importance of telling staff if the patient feels cold at any time during their hospital stay.ExceptionsA Where
15、there is no carer involvedB Where sharing information may compromise the patients confidentiality or wishesSettingsAllStandard100%DefinitionsCarers and relatives should have the opportunity to be involved in decisions about the patients care and treatment, unless the patient specifically excludes th
16、em.Recommendation No.Patient-centred care/1.1.1Preoperative phaseThe preoperative phase is defined as the 1 hour before induction of anaesthesia, during which the patient is prepared for surgery on the ward or in the emergency department, including possible use of premedication. Criterion 3Patients
17、should be assessed for their risk of inadvertent perioperative hypothermia and potential adverse consequences before transfer to the theatre suite. ExceptionsNoneSettingsAcute careStandard100%DefinitionsNoneRecommendation No.1.2.1Criterion 4Patients should be managed as higher risk if any two of the
18、 following apply:- ASA grade II to V - preoperative temperature below 36.0C (and preoperative warming is not possible because of clinical urgency)- undergoing combined general and regional anaesthesia - undergoing major or intermediate surgery - at risk of cardiovascular complications.ExceptionsNone
19、 SettingsAcute careStandard100%DefinitionsASA American Society of AnesthesiologistsRecommendation No.1.2.1Criterion 5Patients temperature should be measured and documented in the hour before they leave the ward or emergency departmentExceptionsNoneSettingsAcute careStandard100%DefinitionsNoneRecomme
20、ndation No.1.2.4Criterion 6Patients whose temperature is below 36.0C should have:- forced air warming started preoperatively on the ward or in the emergency departmentC- forced air warming maintained throughout the intraoperative phase.ExceptionsC Where there is a need to expedite surgery because of
21、 clinical urgencySettingsAcute careStandard100%DefinitionsNoneRecommendation No.1.2.5Intraoperative phaseThe intraoperative phase is defined as total anaesthesia time, from the first anaesthetic intervention through to patient transfer to the recovery area of the theatre suite. Criterion 7Patients t
22、emperature should be measured and documented before induction of anaesthesia and then every 30 minutes until the end of surgeryExceptionsNoneSettingsTheatre suiteStandard100%DefinitionsNoneRecommendation No.1.3.1Criterion 8Patients temperature should be 36C or above before induction of anaesthesia E
23、xceptionsC Where there is a need to expedite surgery because of clinical urgencySettingsTheatre suiteStandard100%DefinitionsNoneRecommendation No.1.3.3Criterion 9The following patients should be warmed intraoperatively from induction of anaesthesia using a forced air warming device: those at higher
24、risk of inadvertent perioperative hypothermia and who are having anaesthesia for less than 30minutes those having anaesthesia for longer than 30 minutesExceptionsNoneSettingsTheatre suiteStandard100%DefinitionsNoneRecommendation No.1.3.7/1.3.8Postoperative phaseThe postoperative phase is defined as
25、the 24 hours after the patient has entered the recovery area of the theatre suite. Criterion 10Patients temperature should be measured and documented on admission to the recovery room and then at 15-minute intervals.ExceptionsNoneSettingsRecovery roomStandard100%DefinitionsNoneRecommendation No.1.4.
26、1Criterion 11Ward transfer should not be arranged unless the patients temperature is 36.0C or above.ExceptionsNoneSettingsRecovery roomStandard0%DefinitionsNoneRecommendation No.1.4.1Criterion 12Patients whose temperature is below 36.0C postoperatively should be actively warmed using forced air warm
27、ing until they are discharged from the recovery room or until they are comfortably warm.ExceptionsNoneSettingsRecovery roomStandard100%DefinitionsComfortably warm is defined as a core temperature of between 36.5 and 37.5C.Recommendation No.1.4.1Number of criterion replaced: Local alternatives to abo
28、ve criteria (to be used where other data addressing the same issue are more readily available)ExceptionsSettingsStandardDefinitionsCriterion 13Healthcare professionals who measure patients temperature with any device should: be aware of, and carry out, any adjustments that need to be made in order t
29、o obtain an estimate of core temperature from that recorded at the site of measurements be aware of any adjustments that are made automatically by the device used.ExceptionsNoneSettingsAcute careStandard100%DefinitionsNone Criterion 14Intravenous fluids of 500ml or more and blood products should be
30、warmed to 37C using a fluid warming deviceExceptionsNoneSettingsTheatre suiteStandard100%DefinitionsNoneNumber of criterion replaced: Local alternatives to above criteria (to be used where other data addressing the same issue are more readily available)ExceptionsSettingsStandardDefinitionsComplete o
31、ne form for each patient. For definitions of the standards, please refer to the audit criteria and/or NICE guideline.Patient identifier:Sex: M / FAge:Operation performed:Ethnicity:Crite-rionNo.DataItemNo.CriterionYesNoNA/ExceptionsNICE guideline ref.Person-centred care and perioperative care1Patient
32、 offered written information about:Person-centred care1.1 the treatment and care they should be offered1.2- including being made aware of the Understanding NICE guidance booklet1.3 the service providing their treatment and care.1.4 the importance of staying warm before surgery to lower the risk of p
33、ostoperative complications1.1.11.5 the possibility of the hospital environment being colder than their home1.6 bringing additional clothing, such as a dressing gown, vest, warm clothing and slippers, to help them keep comfortably warm 1.7 the importance of telling staff if they feel cold at any time
34、 during their hospital stay.(Data source: patient records)2Family and carer(s) offered written information about:Person-centred care2.1 the treatment and care the patient should be offeredA / B2.2- including being made aware of the Understanding NICE guidance booklet A / B2.3 the service providing t
35、he patients treatment and care.A / B2.4 the importance of the patient staying warm before surgery to lower the risk of postoperative complicationsA / B1.1.12.5 the possibility of the hospital environment being colder than the patients homeA / B2.6 bringing additional clothing, such as a dressing gow
36、n, vest, warm clothing and slippers, to help the patient keep warm comfortablyA / B2.7 the importance of telling staff if the patient feel cold at any time during their hospital stay.A / B(Data source: patient records)Preoperative phase - the hour before induction of anaesthesia3Prior to transfer to
37、 the theatre suite, was patient assessed for their risk of:1.2.13.1 inadvertent perioperative hypothermia3.2 potential adverse consequences?44.1Did any of the following apply to the patient:1.2.14.1.1 ASA grade II to V4.1.2- If yes, which grade?4.1.3 preoperative temperature below 36.0C (and preoper
38、ative warming not possible because of clinical urgency)4.1.4 undergoing combined general and regional anaesthesia4.1.5 undergoing major or intermediate surgery4.1.6 at risk of cardiovascular complications (Data source: patient record)55.1Was the patients temperature measured in the hour before trans
39、fer to theatre?1.2.466.16.1.16.1.2If the patients temperature was below 36C did they have: forced air warming started preoperatively:- on the ward or - in the emergency department forced air warming maintained throughout the intraoperative phase?(Data source:patient record)CC1.2.5Intraoperative phas
40、e - as total anaesthesia time, from the first anaesthetic intervention through to patient transfer to the recovery area of the theatre suite.77.1Was the patients temperature documented:1.3.17.1.1 before induction of anaesthesia7.1.2 every 30 minutes until the end of surgery?(Data source: patient rec
41、ord)88.1Before induction of anaesthesia, was the patients temperature 36C or above?(Data source: patient record)C1.3.39Was the patient:9.1.1 at higher risk of inadvertent perioperative hypothermia and having anaesthesia for less than 30 minutes?1.3.79.1.2 having anaesthesia for longer than 30 minute
42、s?1.3.89.1.3If yes to either, was patient warmed intraoperatively from induction of anaesthesia using a forced air warming device?(Data source: patient record)1.3.7/1.3.8Postoperative phase - the 24 hours after the patient has entered the recovery area of the theatre suite. 1010.1Was the patients te
43、mperature documented:1.4.110.1.1 on admission to the recovery room?10.1.2 then at 15 minute intervals?(Data source: patient record)1111.1At time of ward transfer, was the patients temperature 36C or above?(Data source: patient record)1212.1If the patients temperature was below 36C postoperatively, w
44、ere they actively warmed using forced air warming until:12.1.1 they were discharged from the recovery room or12.1.2 until they were comfortably warm (core temperature between 36.5 and 37.5C)?(Data source: patient record)Data collection completedFor definitions of the standards, please refer to the a
45、udit criteria and/or NICE guideline.Organisation/service:Crite-rionNo.DataItemNo.CriterionYesNoNA/Exceptions13Is there a trustwide or local policy or protocol requiring that: 13.1 intravenous fluids of 500ml or more13.2 blood productsare warmed to 37C using a fluid warming device? 14Are all healthcare professionals who routinely measure
