“Peri -operative prevention of maternal and neonatal hypothermia” Ms Aliona Vilinsky BSc, RM, MSc Theatre Department

Background Reason for doing audits: Previous working practices High risk activity  Still some babies drop their temperature regardless staff efforts and evidence based practice Service improvement Professional development Previous working practices Skin to skin in Theatres 1/ 2 and PACU Babies transferred in mothers arms (skin to skin) Temperatures checked twice (after skin to skin in OT/PACU) Maternal temperature was checked twice only in PACU

Objectives Determine where temperature loss occurs: Following delivery During care in PACU During transfer to postnatal wards Determine if mother’s temperature relates to babies temperature loss

Audit Standards Audited against: “NICE (2008) peri-operative prevention of hypothermia” Audits standards summary… Degree of compliance: N=40 (100% compliance) Excluded categories: Babies born vaginaly Babies born outside theatre hours (08:00-16:00) or weekends High risk babies Babies born under Em LSCS Standards: babies dressed with hat and nappy Wrapped 2blankets and a towel Warm under ohio prior removing from OT Check 4 anxilliary temps with the same digital thermometer (say where) Document room temps from each case (both OT and PACU) Babies dressed before T/f to wards

Method & Sample Data collection: Observation Data analysis: statistical analysis of the findings Audit period: 1/4/14 (2 months) Total patient population: 45 patients (5 pilot) Sampling method: first 40 participants that fulfil the criteria

Results Maternal temperature:  38/40 women lost their temperature peri-operatively 33/38 had mild hypothermia 5/38 still normothermic 8/33 used BH in PACU 17/33 declined BH (feeling warm despite their hypothermia) Room mean temperature: 24,3 C PACU mean temperature: 24,8 C SSC mean duration: 33,2’

Results Neonatal temperature: 26/40 babies dropped their temperature 11/40 increased their temperature 3/40 maintained their temperature 13/26 babies became mildly hypothermic out of which: 7 lost T during their SSC in OT 5 lost T during T/F to ward 1 lost T in PACU during BF

Conclusions The majority of the patient loose their T peri-operatively Highest temperature loss occurred during SSC in OT and while transferring the babies to the wards Still not clear if mothers hypothermia is related to neonatal hypothermia Standards were fully met Limitations: Biases Babies heated in the ohio/rescusitare, babies on skin to skin while mothers half-covered with heating blankets “Out of hours” babies not checked

Action plan Action Required Person(s) Responsible Timeframe (delete as appropriate) Progress to date Maternal temperatures to be checked peri-operatively And findings documented OT nurses/midwives To be commenced July 2014 completed Disseminate audit results to theatre staff J. Hickey/ A. Vilinsky To be completed August 2014 RCT pilot study to take place A. Vilinsky To be commenced December 2014 After completion of RCT consider preheating methods peri-operatively J. Hickey/ Anaesthetic team To be completed by the end of 2014 On progress

References Gouchon, S., Gregori, D., Picotto, A., Patrucco, G., Nangeroni, M., and Di Giulio, P. (2010) ‘Skin-to-Skin Contact After Cesarean Delivery: An Experimental Study’. Journal of Nursing Research. 59(2), pp. 78-84. Nolan, A. and Lawrence, C. (2009) ‘A Pilot Study of a Nursing Intervention Protocol to Minimize Maternal-Infant Separation After Cesarean Birth’. Journal of Obstetric, Gynaecologic, & Neonatal Nursing. 38, pp. 430-442. Takahashi, Y., Tamakoshi, K., Matsushima, M., Kawabe, T. (2011) ‘Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin-to-skin contact with different initiation and duration times in healthy, full-term infants’. Early Human Development. 87, pp. 151-157. Waldron, S. and MacKinnon, R. (2007) ‘Neonatal Thermoregulation’. Infant. 3(3), pp. 101-104. World Health Organisation (1997) ‘Thermal protection of the newborn: a practical guide’. Maternal and Newborn Health/Safe Motherhood Unit, Division of Reproductive Health. Geneva: World Health Organisation.