Maternal hypothermia during elective caesarean delivery: A prospective observational study.

BACKGROUND: Patients undergoing caesarean delivery are at risk of developing unintended perioperative hypothermia, defined as a core temperature <36.0°C. Most previous studies of core temperature in caesarean delivery patients have not been conducted with accurate measurements for the complete perioperative period. Therefore, we conducted a prospective observational study to identify the incidence and duration of pre- and post-operative maternal hypothermia with a high accuracy continuous temperature monitoring system. METHODS: Women ≥18 years old presenting for elective caesarean delivery under spinal anaesthesia were invited to participate in the study. The primary outcomes were the incidence and duration of perioperative maternal hypothermia (<36.0°C). Maternal core temperatures were measured with the non-invasive zero-heat-flux thermometer (Bair Hugger Temperature Monitoring System, 3M) throughout the perioperative course. RESULTS: A total of 40 participants were recruited to the study. The incidence of perioperative hypothermia was 32.5%, with a duration of 77 ± 40 min (mean ± standard deviation). The hypothermic patients had similar core temperature as the normothermic patients at baseline preoperatively, but significantly lower temperature at operating room arrival and during the remaining study period. Forty percent of all patients reported thermal discomfort and felt cold on admission to post anaesthesia care unit, whereas 33% had shivering. Neither thermal discomfort nor shivering were associated with hypothermia. CONCLUSION: In the present study almost a third of the women undergoing elective caesarean delivery developed perioperative hypothermia with a core temperature <36.0°C. The mean duration of maternal hypothermia was 77 min, lasting well into the postoperative period for many patients. These data should remind healthcare professionals of the importance of measuring core temperature in all phases of the perioperative setting and to consider optimal warming measures to avoid and treat hypothermia.

Exploring postoperative handover quality in relation to patient condition: A mixed methods study.

AIMS AND OBJECTIVES: To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices. BACKGROUND: High-quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors. DESIGN: Observational mixed methods convergent design. METHODS: Postoperative patient handovers were observed collecting quantitative (n = 109) and qualitative data (n = 48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free-text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research. RESULTS: Information omissions in the handovers observed ranged from 1-13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n = 14). Thematic analysis of the qualitative data identified three themes: "adaptation of handover," "strategies for information transfer" and "contextual and individual factors." Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team. CONCLUSIONS: The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality. RELEVANCE TO CLINICAL PRACTICE: It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality.

Quality in Postoperative Patient Handover: Different Perceptions of Quality Between Transferring and Receiving Nurses.

BACKGROUND: A safe and efficient patient handover is important to ensure high-quality patient care and reduce the risk of patient harm. Few studies have explored handover activities beyond information transfer. PURPOSE: The aims were to assess overall postoperative handover quality and relate quality assessments to handover circumstances, conduct, and teamwork and to compare transferring and receiving nurses' evaluations of handover quality. METHOD: This was a cross-sectional study using the Norwegian Handover Quality Rating Form (N-HQRF). In addition, data were collected on nurses' evaluations of the patient condition, handover preparation, and participating nurses' clinical experience. RESULTS: Although total perceived handover quality was high in a large majority of cases, there were significant differences between transferring and receiving nurses' evaluations of the same handover. Lower-quality handovers had a higher frequency of time pressure, uncertainty, and patient-related problems. CONCLUSION: The findings point to the need to assess handover quality in a wider perspective. Handover circumstances might impact handover quality and should be considered when procedures for handover quality are designed and implemented.

Postoperative patient handovers-Variability in perceptions of quality: A qualitative focus group study.

AIMS AND OBJECTIVES: (a) To explore the factors affecting quality in postoperative handovers as perceived by the different professional groups of clinicians involved. (b) To explore possible differences in perceptions of postoperative handover quality across professional groups and level of experience. BACKGROUND: High quality patient handovers after surgery and anaesthesia are important to ensure patient safety. There is a paucity of research describing contextual factors related to handover quality and the perspectives of different professional groups involved. DESIGN: A qualitative exploratory design was applied. METHOD: A total of eight focus group interviews with 37 participants (29 nurses, eight doctors) were conducted. Anaesthesiologists, resident anaesthesiologists, nurse anaesthetists, postoperative care nurses and operating room nurses participated in the study. The interviews were conducted according to profession with two groups per profession: one with experienced clinicians and one with less experienced clinicians. The data were analysed using thematic analysis. The study adheres to the COREQ guidelines. RESULTS: The data analysis identified the following factors affecting postoperative handover quality: "timing and concurrency conflicts," "handover structure," "patient conditions," "individual characteristics of clinicians involved" and "team composition." Differences across professional groups and level of experience were related to responsibility, structure and adaptation. CONCLUSION: The professional groups involved describe the postoperative patient handover as a complex and variable process that needs to be carefully planned and executed according to the influencing factors. Variability exists across professional groups and level of experience. RELEVANCE TO CLINICAL PRACTICE: Health care providers need to be aware that postoperative handovers are affected by a set of factors related to internal (patient conditions, individual characteristics of clinicians involved and team composition) and external (timing and concurrency conflicts, handover structure) characteristics. These issues need to be acknowledged when procedures and routines for handover quality are designed, implemented and used.