A clinical audit cycle of post-operative hypothermia in dogs

Objectives: Use of clinical audits to assess and improve perioperative hypothermia management in client-owned dogs. Methods: Two clinical audits were performed. Audit 1: data were collected to determine the incidence and duration of perioperative hypothermia (defined rectal temperatures < 37.5˚C). The results from Audit 1 were presented to clinic staff and a consensus reached on changes to be implemented to improve temperature management. Following one month with the changes in place, Audit 2 was performed to assess performance. Results: Audit 1 revealed a high incidence of post-operative hypothermia (88.9%) and prolonged time periods for animals to reach normothermia. Following discussion, a consensus was reached to: 1. measure rectal temperatures hourly post-operatively until a temperature ≥ 37.5˚C was achieved and 2. use a forced air warmer on all dogs until rectal temperature was ≥ 37˚5. After one month with the implemented changes, Audit 2 identified a significant reduction in the time to achieve a rectal temperature of ≥ 37.5˚C, with 75% of dogs achieving this goal by 3.5 hours (7.5 hours for Audit 1, p = 0.01). The incidence of hypothermia at extubation remained high in Audit 2 (97.3% with a rectal temperature < 37.5˚C). Clinical significance: Post-operative hypothermia was improved through simple changes in practice, showing that clinical audit is a useful tool for monitoring post-operative hypothermia and improving patient care. Overall management of perioperative hypothermia could be further improved with earlier intervention.