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

2. 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

3. 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

4. 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

5. 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

6. 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’

7. 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

8. 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

9. 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

10. 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
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
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
Waldron, S. and MacKinnon, R. (2007) ‘Neonatal Thermoregulation’. Infant. 3(3), pp
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.