Construction And Implementation Study Of Intraoperative Hypothermia Prevention In Elderly Patients Undergoing Total Hip Or Total Knee Arthroplasty

Objective:1.Systematic retrieval of relevant research evidence on the prevention and management of intraoperative hypothermia in elderly patients undergoing total hip or total knee arthroplasty,and relevant quality evaluation tools were used to evaluate the quality of the literature,analyze and integrate the research content,and provide evidence-based basis for reducing the occurrence of intraoperative hypothermia in elderly patients.2.Qualitative interview method was used to evaluate the obstacles to the clinical application of the best evidence,and review indicators were developed based on the research results and the recommended items in the summary of the best evidence.3.To explore the effectiveness of intraoperative hypothermia prevention programs in elderly patients undergoing total hip or total knee arthroplasty in reducing the incidence of intraoperative hypothermia and related complications,and nurses’ compliance with evidence-based practice.Methods:1.JBI evidence-based health care model is adopted as the theoretical framework,systematic retrieval guide related websites,professional association websites,Chinese and English electronic literature database on the prevention of hypothermia during total hip or total knee arthroplasty in the elderly,the guidelines,expert consensus,best practice information book,evidence summary,systematic reviews and randomized controlled trial were evaluated with the corresponding quality methodology evaluation tools.Combined with the judgment of professionals,evidence was extracted and summarized for the included literature.2.Qualitative interviews were conducted with medical staff in the joint surgery wards and operating rooms of a grade A hospital in Shandong Province by phenomenological method,and obstacles to the clinical application of best evidence were analyzed,review indicators were formulated based on research results and best evidence.3.Carry out clinical practice of evidence-based preventive measures in pilot departments,construct and implement evidence-based reform programs through baseline review,and verify the effectiveness of evidence application from the perspective of patients,nurses and organizations respectively.Results:1.This study included 14 literatures,including 3 evidence-based clinical practice guidelines,3 expert consensus,5 systematic reviews,1 evidence summary and 2 randomized controlled trials.A total of 36 best evidences were collected and integrated from 5 aspects,including preoperative assessment and education,intraoperative assessment and management,monitoring time and site,equipment,supervision and training.2.Qualitative interviews were conducted with 9 stakeholders,and 4 obstacles were identified:insuficient attention of medical staff to the prevention and management of intraoperative hypothermia,insufficient evidence recognition and acquisition;Lack of effective assessment of the high-risk group of hypothermia,improper use of assessment tools,lack of awareness of active insulation;Lack of training and assessment on the correct use of instruments and equipment for the prevention of intraoperative hypothermia;Intraoperative hypothermia prevention and management needs the cooperation of the team and multiple departments,and the operation process and system of hypothermia prevention and management are lacking in clinical.3.Evidence application studies showed that patient,nurse and organizational outcome indicators were respectively:(1)Patient-level:① After evidence application,the incidence of intraoperative hypothermia in elderly patients with total hip or total knee arthroplasty decreased from 26.67%to 9.68%,the difference was statistically significant(P<0.05).② After evidence application,the incidence of postoperative chills in elderly patients with total hip or total knee arthroplasty decreased from 8.89%to 0,the difference was statistically significant(P<0.05).(2)Nurse-level:①After the application of evidence,the implementation rate of nurses on the 14 review indicators increased from<50%to>70%,compliance has improved significantly.② After evidence application,the scores of evidence-based nursing ability of nurses in evidence formation,evidence integration,evidence dissemination and evaluation,and evidence application ability were significantly improved,the difference was statistically significant(P<0.05).③ After evidence application,the knowledge awareness of nurses in preoperative assessment and education,intraoperative assessment and management,monitoring time and site,equipment,supervision and training were significantly improved(P<0.05).(3)Organization-level:The department formulated and further improved the intraoperative hypothermia prevention procedures and standards,inspection forms,evaluation records and training materials.Conclusion:This study based on the JBI model of evidence-based health care,combining with the qualitative interviews with stakeholders,preliminarily constructed a good clinical applicability prevention programs of intraoperative hypothermia in elderly patients with total hip or total knee arthroplasty,guide nurses correctly identify high-risk patients,targeted to the implementation of the individual prevention measures,regulate body temperature monitoring site and heat preservation time,correctly use heat preservation equipment,improve the intraoperative temperature protection process,effectively reduce the occurrence of intraoperative hypothermia and related complications,expanded the professional knowledge of nurses,improve the practice compliance and evidence-based nursing ability of nurses,improved the relevant process system of the department,improved the cultural atmosphere of the team,improved the quality of care and patients safety.