Clinical application of multidisciplinary team- and evidence-based practice project in gynecological patients with perioperative hypothermia

Table 4 Relationship between evidence, practice protocol related documentation and examination indicators

Stage	Evidence suitable for clinical scenarios	Practice protocol related documentation	Examination indicators	Examination objectives and methods
Preoperative ward	To educate patients on thermal insulation and matters needing attention before surgery	Manuals and videos of perioperative health education (patient edition)	The operating room has propaganda materials on hypothermia prevention and management	Department: Document consultation
			Checking the preoperative follow-up sheet of gynecological surgery patients	Medical staff: Document consultation and observation
	To measure and record the patient’s axillary temperature before surgery	Surgical patient handover/transfer proforma	Checking the surgical patient handover/transfer proforma	Medical staff: Document consultation and observation
	To actively warm patients whose body temperature is below 36°C to 36°C and keep the patient warm during transfer	Hypothermia emergency procedures	The operating room has a hypothermia emergency process to ensure continuous heat preservation during patient transfer	Medical staff: Document consultation and observation
Preoperative operating room	To assess the risk factors for hypothermia in patients	Hypothermia risk factor evaluation sheet	The operating room has an evaluation sheet to evaluate the risk factors of hypothermia in patients	Operating Room: document consultation
	To use a temperature monitoring equipment to measure and record the patient’s body temperature before anesthesia induction	Procedure for the use of temperature monitoring equipment	Before anesthesia induction, a temperature monitoring equipment is used for patients with operation duration of 2h or longer	Medical staff: Observation and document consultation
	To actively warm patients whose body temperature is below 36°C to above 36°C	Active heat preservation methods for hypothermia patients	Effective warming strategies are taken for hypothermia patients	Medical staff: Observation and document consultation
	To preheat 10-30 min before anesthesia induction	Pre-heat preservation methods	10-30 min of pre-heat preservation is performed on gynecological patients before anesthesia induction	Medical staff: Observation
	To maintain the operating room temperature no less than 24°C, and to lower the temperature only when active heating is established	-	The operating room ambient temperature is adjusted to 24°C and above before surgery	Medical staff: Observation
Intraoperative operating room	To adopt an effective comprehensive thermal insulation strategy after anesthesia and maintain the axillary temperature at least 36.5°C	Intraoperative comprehensive thermal insulation strategies (active and passive thermal insulation, blood transfusion and infusion warming, continuous dynamic monitoring of body temperature, etc.)	According to the probability of hypothermia in gynecological patients during operation, a corresponding comprehensive heat preservation strategy is selected to maintain the axillary temperature of the patient at least 36.5°C	Medical staff: Observation, document consultation
	To expose the surgical area and cover the rest for thermal insulation	-	The surgical area is exposed and the rest is covered for thermal insulation	Medical staff: Observation
	To warm the intravenous fluid or blood transfusion with a warming device to 37°C if the amount was ≥ 500 mL	Procedure for the use of infusion pipeline heating instrument	The infusion pipeline was warmed for those with a intravenous fluid or blood transfusion volume ≥ 500 mL	Medical staff: Observation
	To heat the intraoperative washing solution with a thermostatic chamber to 38-40°C	-	The washing solution is used at 38-40°C	Medical staff: Observation
	To continuously monitor and record the patient’s body temperature once every 30 min intraoperatively, and to record it once every 15 min during recovery from anesthesia	-	The body temperature is continuously monitored and recorded on time intraoperatively	Medical staff: Observation, document consultation
	To evaluate hypothermia symptoms and signs during the operation	Evaluation methods of symptoms and signs of hypothermia in patients during operation	The patient is observed for symptoms and signs of hypothermia during the operation	Medical staff: Observation
PACU	To measure the body temperature and record it every 15 min. Passive thermal insulation is adopted for those without hypothermia, and active thermal insulation is taken to above 36°C for those below 36°C	Active insulation methods and temperature handover record for hypothermia patients	The patient’s temperature is measured and the hypothermia patients are warmed effectively, and the temperature handover record is established	Medical staff: Observation, document consultation
	To adjust the PACU ambient temperature to 24°C	-	The PACU temperature is adjusted to 24°C and above	Medical staff: Observation
	To send the patient back to the ward when the body temperature is not lower than 36°C	-	The patient is transferred out from the PACU only when the body temperature is ≥ 36℃	Medical staff: Observation, document consultation
24-hour postoperative gynecological ward	To monitor and record the patient's axillary temperature every 4 h	-	The patient's axillary temperature is measured and recorded every 4 h	Medical staff: Observation, document consultation
	To cover to keep warm	-	The patient is covered to keep warm	Medical staff: observation
	To teach the patient's family how to keep warm effectively	Health education handbook	The patient’s family members' are informed of effective thermal insulation methods	Medical staff: Observation and questioning
	To continuously and actively warm patients below 36°C until they feel warm and comfortable, and to monitor and record every 30 min	Active heat preservation methods for hypothermia patients	The hypothermia patients are continuously and actively warmed, with their body temperatures monitored and recorded every 30 min	Medical staff: Observation, document consultation
	To evaluate the patient's thermal comfort level	Thermal comfort rating scale	The patient's thermal comfort level is assessed	Medical staff: Document consultation

PACU: Postanesthesia care unit.