Authors (including presenting author) :
Chan CYC(1), Cheung MH(1), Chow SL (1), Fan SY (1), Kwok CM(1), Ng HM(1), Ng WY(1), Shum HP(1), Lo WP(1), Kwan KW(1), Yeung KJ(1)
Affiliation :
(1)Intensive Care Unit, Pamela Youde Nethersole Eastern Hospital
Introduction :
Target temperature management (TTM) is crucial for Intensive Care Unit (ICU) patients with acute neurological injuries (ANI) to prevent secondary brain damage. However, due to lack of consensus and knowledge gap between nurses and doctors, the discrepancies among various cooling methods, timing to act, also monitoring frequency could have adverse impact on patient neurological outcomes. An algorithm aimed at standardizing nurses' management towards ANI was therefore created and its effectiveness was evaluated.
Objectives :
(1) to standardize target temperature management on patient with ANI, and increase staff’s compliance rate (2) to reduce fever episode of patients with acute neurological injuries (3) to enhance the colleagues’ knowledge towards TTM
Methodology :
A systematic use of TTM protocol and an algorithm were designed and implemented from 1st January to 2nd June 2024. Online quizzes regarding TTM were performed during the pre and post-education period for comparison. There were 56 and 55 neurological patients admitted to our unit in pre-intervention and post-intervention phase respectively. 31 out of 56 and 24 out of 55 patients developed fever and were recruited. Data of fever episodes and nurses’ corresponding managements were collected to compare the effectiveness of the project.
Result & Outcome :
In comparison to pre and post-intervention groups of 65 patients, there were decreases in the average percentage in fever episodes (38.73% to 27.3%), maximum temperature (40.4°C to 39°C), median temperature (37.4°C to 37.1°C), mean temperature (37.35°C to 37.15°C) and average longest duration of fever (20.91 hours to 10.17 hours), implying a better temperature control upon the implementation of TTM project. The post-intervention compliance rate had increased by 17.45%, representing higher nurses’ awareness towards early temperature control and prompt implementation of first-line cooling methods. Furthermore, an increment by 40% of the total quiz score and 25% increase in nurses’ self-rated confidence level in handling water-circulating cooling devices in the post-education quiz, indicated a strengthened nurses’ knowledge on TTM. TTM in patients with ANI in ICU is a key component in improving patients’ neurological outcomes. The introduction of TTM protocol standardized the target temperature, TTM pharmacological appraoch in collaboration with doctors and nurse initiated TTM workflow, thus facilitated in reducing fever episodes. With enhancement of nurses compliance and knowledge in TTM protocol, this protocol may include more target groups with possible neurological injuries (i.e. patients with post-cardiac arrest) in the future. We also hope to incorporate new technologies on continuous core temperature monitoring with less invasiveness and better accuracy to further simplify the current TTM protocol.
