Improving Thermoregulation for Trauma Patients in the Emergency Department: An Evidence-Based Practice Project

Abstract

Extensive evidence exists on the association between hypothermia and increased morbidity and mortality in trauma patients. Gaps in practice related to temperature assessment have been identified in literature, along with limited personnel knowledge regarding management of patients with accidental hypothermia. An interdisciplinary team identified gaps in practice in our institution regarding temperature assessment and documentation of rewarming and initiated an evidence-based practice project to change practice at our institution. The goals were to decrease time to temperature assessment, increase core temperature assessment, and increase implementation of appropriate rewarming methods. This project used the Iowa Model of Evidence-Based Practice to provide a framework for execution and evaluation. We conducted a literature review to address all aspects of hypothermia, including incidence, associated and contributing factors, prevention, recognition, and treatment. This evidence-based knowledge was then applied to clinical practice through staff education and training, equipment availability, and environmental adjustments. More patients with hypothermia and hyperthermia were identified in 2017, as compared with 2016. There was a significant increase in core temperature assessment from 4% in 2016 to 23% in 2017 (p < .001). Blanket use in normothermic patients increased in 2017 (p = .002). This project is an example of how nurses can utilize an evidence-based practice model to translate research into clinical practice. Best practice interventions regarding temperature assessment and rewarming measures for trauma patients can be successfully implemented with negligible cost. Further research should be dedicated to examine barriers to implementation and adherence to evidence-based practice interventions.

The Effect of Thermal Care Workshop on EMS Staff Readiness in managing Accidental Hypothermia in Trauma Patients

“…In this study, the mean value of the nurses' knowledge was significantly different after instructional intervention [30]. Saqe-Rockoff et al (2018) completed an evidence-based project on the improvement of the trauma patients' temperature regulation and reported that the implementation of an evidence-based instructional intervention improved the emergency nurses' performance in regard to patient thermal care [24]. Other studies have often focused on the inadequacy of the knowledge and performance of physicians, nurses, and the other people who are involved in trauma patient care and have emphasized the need to take effective measures to improve staff information and skills for the optimal management of hypothermia in these patients.…”

“…Treatment strategies focus on prevention of heat loss, fluid resuscitation, and implementation of appropriate warming techniques and management of cardiac dysrhythmias [23]. Weaknesses in the assessment of patient's body temperature and limited staff knowledge of the management of patients with hypothermia have been identified in several studies [22,24,25]. Recording temperature in trauma patients is an essential requirement to help the physician make informed decisions to manage hypothermia and to evaluate the effectiveness of the rewarming method.…”

Accidental hypothermia and related risk factors among trauma patients in prehospital setting

“…In addition to a lack of staff training on how to handle patients who have accidentally become hypothermic, gaps in practice relating to temperature assessment have been found in the literature. Rewarming techniques are employed in prehospital care to enhance patient outcomes and lessen the discomfort imposed by colds [6,27]. Therefore, in their work, physicians, nurses, and emergency paramedics must follow evidence-based guidelines.…”

“…There is more data supporting the link between hypothermia and higher morbidity and death rates in trauma patients. Even mild hypothermia can greatly enhance morbidity in trauma victims [5,6]. The mortality rate in trauma patients is significantly increased by hypothermia combined with acidosis and coagulopathy [7].…”

Cuidado de enfermagem no reaquecimento seguro de pacientes hipotérmicos: scoping review

“…A hipotermia é uma complicação que pode contribuir para a deterioração do quadro clínico dos pacientes hospitalizados, sendo uma urgência que requer rápida e eficaz intervenção do enfermeiro para o restabelecimento da normotermia, a fim de evitar maiores prejuízos ao paciente. Em unidades de emergência, a alta mortalidade está associada a acidentes, a hipotermia por exposição e lesões traumáticas graves, complicações como a coagulopatia e a acidose metabólica é considerada como "tríade letal" 1,2 .…”