Who Knows the Temperature?

We are in our survey window for The Joint Commission and, as every biomed knows, this means a continuous barrage of consultants visiting our facility. The consultants are necessary to help us open our eyes and to look differently at our environment. They help to identify areas that need improvement.  We recently had a consultant come through our facility and she identified discrepancies with temperatures of blanket warmers. I was asked to help correct the problem and felt it would be simple. I soon discovered that it was anything but simple.

The issue was discovered when the consultant was walking through our same-day surgery area and noticed blanket warmers set at various temperatures from 130 to 150 degrees. After questioning staff and the department manager, the consultant and our compliance officer began a thorough review of the policy and visited every blanket warmer in the facility. They discovered that our policy states that all blanket warmers will not exceed 130 degrees Fahrenheit per ECRI recommendations. Since we were not following our stated policy, the consultant included this in her report to hospital leadership. Leadership promptly decreed that all recommendations required an action plan by the end of the week!

Because I am the administrator of our remote temperature monitoring solution, the nursing team came to me to help them with a solution. It was assumed by hospital leadership that automatic monitoring would be the answer to the problem. I, however, wanted to do a little more research. I sent my team out to locate and record the temperatures of all the blanket warmers. We found blanket warmers at temperatures between 130 and 160 degrees Fahrenheit. However, when my staff tried to adjust the temperatures to the stated policy temperature of 130 degrees they received a fair amount of push back from nursing. In some areas of the hospital, the nursing staff felt that the blankets were too cold for their patient population. They wanted to keep them at 150 degrees. Also, the nursing staff was not too excited about automated temperature monitoring.

I met with several key stakeholders to discuss their blanket warmer usage and their thoughts about the automatic temperature monitoring solution. On the surface, automatic temperature monitoring seems like the natural solution. It documents the temperature in real time and sends alerts to the nursing staff when the unit is out of range. It ensures compliance by keeping an electronic record of the temperature and any alarms. However, when you factor in the cost and maintenance of the tags and addressing the alerts, the nursing staff turned cold to the idea. It seemed expensive and time consuming to them. They asked me questions like, “Why do I care what the temperature is off hours? What happens if the unit is out of range and the person the system notifies is busy? Isn’t there a simpler solution?” After these meetings, I spent time researching what others do in the industry to help us find a simple solution.

The first issue I researched was the appropriate temperature for a blanket warmer. The ECRI Institute recommends warmers should not be more than 130 degrees. I also found a study published in the AORN Journal evaluating the effect of blankets at 150 degrees. There is not a nationally recognized standard for blanket warmer temperature. We decided to do our own risk assessment based on information gathered from various sources. The second issue we addressed is the monitoring of the temperature. After walking through the process of utilizing automatic monitoring, we found holes in the process. The biggest issue is that our temperature monitoring system sends alerts through email and pages, but do not alarm locally. It is conceivable that staff could remove a “too hot” blanket and put it on a patient. It was discovered that because everyone knows the system records automatically no one pays attention to the actual temperature.

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After more discussion with users, and some observations of staff using blanket warmers, I proposed a solution. To address temperature, we decided to adopt 130 to 150 degree standard. However, the default temperature setting is 130 degrees. If departments request 150 degrees for their blanket warmer, we (biomedical) conduct a risk assessment on the unit based on the following criteria: How far is the blanket warmer from the care area? Are blankets applied to unconscious patients? Has there ever been a patient complaint of a too hot blanket? And, are blankets resupplied more than once a day? Depending on the answers to these questions, we determine if 150 degrees was a safe temperature for the unit.

To address monitoring, we decided that when staff removes a blanket they look at the posted temperature range on the unit and observe the internal temperature readout to ensure that the unit is in range. If the unit is out of range, they are to not use the blanket and document their action on an attached action sheet. We felt this is better than automatically monitoring because staff will be trained to notice the temperature real time and to react appropriately.

I was surprised at how long this took to solve. Most of the nurses I worked with shared that they felt this was silly because if they grabbed a blanket from a warmer and it was too hot for them to handle it they would never put it on a patient. I agree with them; however we often have to prove to our inspectors that we are doing the right things for our patients.

Jim Fedele, CBET, has been with Medical Dealer magazine for more than 15 years. He is currently the director of clinical engineering for Susquehanna Health Systems in Williamsport, Pa. He can be reached for questions and/or comments by email at info@mdpublishing.com.